Healthcare Provider Details

I. General information

NPI: 1174240550
Provider Name (Legal Business Name): KATHRYN ANN KIRK RRT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2022
Last Update Date: 10/26/2022
Certification Date: 10/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 W COURT SQ
LIVINGSTON TN
38570-1882
US

IV. Provider business mailing address

102 W COURT SQ
LIVINGSTON TN
38570-1882
US

V. Phone/Fax

Practice location:
  • Phone: 931-303-3561
  • Fax: 615-658-9303
Mailing address:
  • Phone: 931-303-3561
  • Fax: 615-658-9303

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number6747
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: