Individual
LARISSA DYAN KIRK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1631 E 2ND ST, AUSTIN, TX 78702-4490
(512) 455-7787
Mailing address
1430 COLLIER ST, AUSTIN, TX 78704-2911
(512) 472-4357
(512) 703-1394
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
19572
NE
Other
Enumeration date
03/08/2018
Last updated
03/08/2018
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