Provider Demographics
NPI:1285734145
Name:KIRK, ROBERT VERNON (PSYD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:VERNON
Last Name:KIRK
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 W 42ND ST
Mailing Address - Street 2:SUITE 3200 MEDICAL PLAZA NORTH
Mailing Address - City:SCOTTSBLUFF
Mailing Address - State:NE
Mailing Address - Zip Code:69361-0617
Mailing Address - Country:US
Mailing Address - Phone:308-635-3888
Mailing Address - Fax:308-630-1817
Practice Address - Street 1:2 W 42ND ST
Practice Address - Street 2:SUITE 3200 MEDICAL PLAZA NORTH
Practice Address - City:SCOTTSBLUFF
Practice Address - State:NE
Practice Address - Zip Code:69361-0617
Practice Address - Country:US
Practice Address - Phone:308-635-3888
Practice Address - Fax:308-630-1817
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2009-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE709103TC0700X
UT329152-2501103TC0700X
WV866103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical