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General NPI Number Information
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NPI Number | 1235262924
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Entity Type | Individual
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Provider Name | JESSICA DAWN KIRK FNP
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Gender | Female
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Dates
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Enumeration Date | 03/13/2007
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Last Update Date | 06/06/2025
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Provider Practice Location Address
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Address Line | 1801 S BROADWAY ST.
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City | PITTSBURG
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State | KS
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Zip | 66762
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Country | US
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Telephone | 888-777-9170
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1832
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City | PITTSBURG
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State | KS
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Zip | 66762-1832
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Country | US
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Telephone |
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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 | 2002026638
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 77419
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License Number State | KS
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