Basic Information
| Provider Information | |||||||||
| NPI: | 1265032528 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KIRK | ||||||||
| FirstName: | MEAGHAN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 268 W 5TH ST | ||||||||
| Address2: | |||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021272617 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3397880878 | ||||||||
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| Practice Location | |||||||||
| Address1: | 479 WASHINGTON ST | ||||||||
| Address2: | |||||||||
| City: | QUINCY | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021695895 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8575295220 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/27/2020 | ||||||||
| LastUpdateDate: | 10/13/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/13/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | RN2330123 | MA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 163W00000X | RN2330123 | MA | N | Nursing Service Providers | Registered Nurse |
No ID Information.