Individual
KATHRYN KIRK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APN
Contact information
Practice address
1006 E 18TH ST, CAMERON, TX 76520-2016
(254) 495-7702
Mailing address
PO BOX 2652, SAN ANTONIO, TX 78299-2652
(254) 495-7702
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
239473
TX
363LG0600X
Gerontology Nurse Practitioner
Primary
239473
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00954U
C&K GROUP MCB #
—
01
—
00Z020
MEDICARE GROUP #
—
05
—
029330002
—
TX
05
—
029330003
—
TX
Enumeration date
06/26/2006
Last updated
10/14/2008
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