Provider Demographics
NPI:1104586163
Name:KIRK, RANDI NICOLE ELOISE (PMHNP)
Entity type:Individual
Prefix:MRS
First Name:RANDI
Middle Name:NICOLE ELOISE
Last Name:KIRK
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
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Mailing Address - Street 1:PO BOX 1832
Mailing Address - Street 2:
Mailing Address - City:PITTSBURG
Mailing Address - State:KS
Mailing Address - Zip Code:66762-1832
Mailing Address - Country:US
Mailing Address - Phone:888-777-9170
Mailing Address - Fax:620-231-5062
Practice Address - Street 1:2100 COMMERCE DR
Practice Address - Street 2:
Practice Address - City:PARSONS
Practice Address - State:KS
Practice Address - Zip Code:67357-4951
Practice Address - Country:US
Practice Address - Phone:620-717-4450
Practice Address - Fax:620-717-4540
Is Sole Proprietor?:No
Enumeration Date:2021-12-17
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KS53-80775-092363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health