Healthcare Provider Details

I. General information

NPI: 1164973558
Provider Name (Legal Business Name): JODI FRANCES KIRK FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2016
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1623 N 1ST ST
HERMISTON OR
97838-1106
US

IV. Provider business mailing address

1623 N 1ST ST
HERMISTON OR
97838-1106
US

V. Phone/Fax

Practice location:
  • Phone: 458-300-9014
  • Fax: 458-300-9015
Mailing address:
  • Phone: 458-300-9014
  • Fax: 458-300-9015

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP70018808
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number10045902
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP9019
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: