Basic Information
| Provider Information | |||||||||
| NPI: | 1962754184 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KIRK | ||||||||
| FirstName: | LARRY | ||||||||
| MiddleName: | CRAIG | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5141 VIRGINIA WAY | ||||||||
| Address2: | STE 390 | ||||||||
| City: | BRENTWOOD | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370279505 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6159338073 | ||||||||
| FaxNumber: | 6159881635 | ||||||||
| Practice Location | |||||||||
| Address1: | 2615 CHESTER AVENUE | ||||||||
| Address2: | SAN JOAQUIN COMMUNITY HOSPITAL | ||||||||
| City: | BAKERSFIELD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 93301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2565481487 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/11/2012 | ||||||||
| LastUpdateDate: | 06/29/2016 | ||||||||
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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 | 363A00000X | 22605 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.