MEDICARE: BRYAN E KIRK, LLC

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	679387	TX

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	:	1801264775
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRYAN E KIRK, LLC

Provider Business Mailing Address
First Line	:	PO BOX 9632
Second Line	:
City	:	WICHITA FALLS
State	:	TX
Zip	:	76308-9562
Country	:	US
Telephone Number	:	940-322-5477
Fax Number	:	940-720-0018

Provider Business Practice Location Address
First Line	:	1708 DAYTON AVE
Second Line	:
City	:	WICHITA FALLS
State	:	TX
Zip	:	76301-6110
Country	:	US
Telephone Number	:	940-322-5477
Fax Number	:	940-720-0018

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	MR. BRYAN E KIRK
Credential	:	PMH-NP
Telephone Number	:	940-631-7066

Provider Enumeration Date	:	09/09/2015
Last Update Date	:	01/11/2017

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Directions to “BRYAN E KIRK, LLC ” Practice Location

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