Basic Information
| Provider Information | |||||||||
| NPI: | 1366061616 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KIRK | ||||||||
| FirstName: | KRISTA | ||||||||
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| Credential: | APN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4201 WINFIELD RD FL 3 | ||||||||
| Address2: | |||||||||
| City: | WARRENVILLE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 605554025 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3312216377 | ||||||||
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| Practice Location | |||||||||
| Address1: | 133 E BRUSH HILL RD STE 310 | ||||||||
| Address2: | |||||||||
| City: | ELMHURST | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601265662 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3312219003 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/15/2020 | ||||||||
| LastUpdateDate: | 03/02/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/02/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 209022007 | IL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 163WC0200X | 041.416140 | IL | N | Nursing Service Providers | Registered Nurse | Critical Care Medicine |
No ID Information.