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General NPI Number Information
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NPI Number | 1053891168
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Entity Type | Individual
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Provider Name | KEVIN M DIRKSEN APRN-CNP
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Gender | Male
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Dates
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Enumeration Date | 08/17/2018
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Last Update Date | 10/09/2025
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Provider Practice Location Address
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Address Line | 830 W MAIN ST
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City | COLDWATER
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State | OH
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Zip | 45828-1626
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Country | US
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Telephone | 419-678-8446
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Fax | 419-678-5996
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Provider Business Mailing Address
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Address Line | 200 SAINT CLAIR AVE
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City | SAINT MARYS
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State | OH
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Zip | 45885-2400
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Country | US
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Telephone | 419-300-1129
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Fax | 419-394-9575
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | APRN.CNP.023488
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License Number State | OH
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