Basic Information
| Provider Information | |||||||||
| NPI: | 1609432202 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KIRK | ||||||||
| FirstName: | CARISSA | ||||||||
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| Credential: | NP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 550 | ||||||||
| Address2: | |||||||||
| City: | VANCEBURG | ||||||||
| State: | KY | ||||||||
| PostalCode: | 411790550 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6069560162 | ||||||||
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| Practice Location | |||||||||
| Address1: | 502 S 2ND ST | ||||||||
| Address2: | |||||||||
| City: | RIPLEY | ||||||||
| State: | OH | ||||||||
| PostalCode: | 451671306 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9377444343 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/20/2019 | ||||||||
| LastUpdateDate: | 11/19/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/19/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | APRN.CNP.024507 | OH | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.