Individual
DESIREE D KIRK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
AGNP
Contact information
Practice address
17727 E BURNSIDE ST, PORTLAND, OR 97233
(503) 215-9800
Mailing address
17727 E BURNSIDE ST, PORTLAND, OR 97233
(503) 215-9800
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
10010097
OR
363LG0600X
Gerontology Nurse Practitioner
Primary
10010097
OR
Other
Enumeration date
09/26/2023
Last updated
10/31/2024
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