MEDICARE: MRS. GINA KIRK FNP

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	363LF0000X	Family Nurse Practitioner	RN119650NP	GA

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	:	1811982127
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. GINA KIRK FNP

Provider Business Mailing Address
First Line	:	200 GA HIGHWAY 49 S
Second Line	:
City	:	BYRON
State	:	GA
Zip	:	31008-6937
Country	:	US
Telephone Number	:	478-956-2648
Fax Number	:	478-956-4080

Provider Business Practice Location Address
First Line	:	200 HWY 49 S
Second Line	:
City	:	BYRON
State	:	GA
Zip	:	31008-6937
Country	:	US
Telephone Number	:	478-956-2648
Fax Number	:	478-956-4080

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/13/2005
Last Update Date	:	10/13/2025

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