MEDICARE: WILLIAM KIRK RN

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	163WC0400X	Case Management Registered Nurse	6013467	TX

General Provider Information

NPI Number	:	1831858380
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILLIAM KIRK RN

Provider Business Mailing Address
First Line	:	3228 SCHOFIELD RD # 3822
Second Line	:
City	:	FORT SAM HOUSTON
State	:	TX
Zip	:	78234-4504
Country	:	US
Telephone Number	:	210-808-6677
Fax Number	:

Provider Business Practice Location Address
First Line	:	3228 SCHOFIELD RD # 3822
Second Line	:
City	:	FORT SAM HOUSTON
State	:	TX
Zip	:	78234-7603
Country	:	US
Telephone Number	:	210-748-0092
Fax Number	:

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

Provider Enumeration Date	:	12/13/2021
Last Update Date	:	12/13/2021

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