Basic Information
| Provider Information | |||||||||
| NPI: | 1740686369 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KIRK | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | CHRISTOPHER | ||||||||
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| Credential: | PMHNP-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2050 VOORHEES TOWN CENTER | ||||||||
| Address2: | |||||||||
| City: | VOORHEES | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080431910 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8563460005 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1000 WHITE HORSE RD STE 802 | ||||||||
| Address2: | |||||||||
| City: | VOORHEES | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080434414 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8565247243 | ||||||||
| FaxNumber: | 8565247365 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/10/2014 | ||||||||
| LastUpdateDate: | 03/17/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0808X | SP014185 | PA | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health | 363LP0808X | 26NJ005333100 | NJ | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
No ID Information.