MEDICARE: KAREN S. KIRK, PHD, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency
2	103TC0700X	Clinical Psychologist	3894	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1588912513
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KAREN S. KIRK, PHD, PLLC

Provider Business Mailing Address
First Line	:	P.O. BOX 16570
Second Line	:
City	:	WILMINGTON
State	:	NC
Zip	:	28408
Country	:	US
Telephone Number	:	910-202-9113
Fax Number	:	910-202-9289

Provider Business Practice Location Address
First Line	:	2601 IRON GATE DR STE 101
Second Line	:
City	:	WILMINGTON
State	:	NC
Zip	:	28412-6624
Country	:	US
Telephone Number	:	910-202-9113
Fax Number	:	910-202-9289

Authorized Official
Title or Position	:	OWNER / MANAGER
Name	:	DR. KAREN S. KIRK
Credential	:	PHD
Telephone Number	:	910-202-9113

Provider Enumeration Date	:	08/23/2012
Last Update Date	:	10/06/2022

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