Basic Information
| Provider Information | |||||||||
| NPI: | 1871555300 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BARRON | ||||||||
| FirstName: | KIRK | ||||||||
| MiddleName: | W | ||||||||
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| Credential: | P.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1250 8TH AVE | ||||||||
| Address2: | SUITE 135 | ||||||||
| City: | FORT WORTH | ||||||||
| State: | TX | ||||||||
| PostalCode: | 76104 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8173328848 | ||||||||
| FaxNumber: | 8173352670 | ||||||||
| Practice Location | |||||||||
| Address1: | 1250 8TH AVE | ||||||||
| Address2: | SUITE 135 | ||||||||
| City: | FORT WORTH | ||||||||
| State: | TX | ||||||||
| PostalCode: | 76104 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8173328848 | ||||||||
| FaxNumber: | 8173352670 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/03/2006 | ||||||||
| LastUpdateDate: | 11/26/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AS0400X | PA04583 | TX | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical | 363A00000X | PA04583 | TX | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 363AM0700X | PA04583 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
ID Information
| ID | Type | State | Issuer | Description | P00784417 | 01 | TX | RAILROAD MEDICARE | OTHER | 194565101 | 05 | TX | MEDICAID | 8Y8718 | 01 | TX | BCBS | OTHER |