Individual
KEVIN M DIRKSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
APRN-CNP
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
APRN.CNP.023488
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0105065
GROUP MEDICAID - JTDM FAMILY PRACTICE, LLC
OH
05
—
0313733
—
OH
01
—
9934723
GROUP PTAN - JTDM FAMILY PRACTICE, LLC
OH
01
—
H674260
MEDICARE
OH
Enumeration date
08/17/2018
Last updated
10/09/2025
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