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General NPI Number Information
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NPI Number | 1942019294
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Entity Type | Individual
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Provider Name | DONELLE KAY KIRK
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Gender | Female
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Dates
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Enumeration Date | 01/02/2025
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Last Update Date | 01/02/2025
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Provider Practice Location Address
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Address Line | 102 S PORTLAND AVE
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City | HARTINGTON
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State | NE
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Zip | 68739-5031
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Country | US
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Telephone | 402-649-0976
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Fax |
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Provider Business Mailing Address
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Address Line | 417 E MAIN ST
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City | BLOOMFIELD
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State | NE
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Zip | 68718-2010
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Country | US
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Telephone | 402-649-0976
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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 | 372600000X
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Taxonomy Name | Adult Companion
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License Number | 88440426
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License Number State | NE
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