Individual
NICOLE DEE KIRK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
4747 S BROADWAY AVE, WICHITA, KS 67216-1739
(316) 529-3084
Mailing address
4747 S BROADWAY AVE, WICHITA, KS 67216-1739
(316) 993-8123
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
5379282012
KS
363LF0000X
Family Nurse Practitioner
F01200572
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
112613
KSBN-RN
KS
01
—
1598378986
NPI
KS
05
—
201337300A
—
KS
01
—
53-79282-012
KANSAS STATE BOARD OF NURSING
KS
Enumeration date
08/26/2020
Last updated
09/08/2021
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