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Organization
WILLIAM D. KIRK M.D., PLLC
Active
Organization
WILLIAM D. KIRK M.D., PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. WILLIAM DEADRICK KIRK M.D. (OWNER)
(270) 692-9559
Entity
Organization
Contact information
Practice address
312 W HIGH ST, LEBANON, KY 40033-1428
(270) 692-9559
(270) 692-9236
Mailing address
312 W HIGH ST, LEBANON, KY 40033-1428
(270) 692-9559
(270) 692-9236
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
—
KY
207Q00000X
Family Medicine Physician
26011
KY
207R00000X
Internal Medicine Physician
26011
KY
363LF0000X
Family Nurse Practitioner
Primary
26011
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2442987001
PASSPORT ADVANTAGE
KY
01
—
50001390
PASSPORT
KY
05
—
78903242
—
KY
05
—
9590111200
—
KY
Enumeration date
10/05/2006
Last updated
10/06/2015
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