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General NPI Number Information
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NPI Number | 1063950160
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Entity Type | Individual
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Provider Name | KACY MIKALA KIRK NP
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Gender | Female
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Dates
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Enumeration Date | 02/08/2017
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Last Update Date | 11/12/2021
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Provider Practice Location Address
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Address Line | 1803 N JACKSON ST
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City | TULLAHOMA
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State | TN
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Zip | 37388-2201
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Country | US
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Telephone | 931-455-3400
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Fax |
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Provider Business Mailing Address
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Address Line | 183 ROBERTS CREEK CIR
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City | MANCHESTER
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State | TN
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Zip | 37355-3690
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Country | US
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Telephone | 931-607-2531
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Fax |
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 22311
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License Number State | TN
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