Provider Demographics
NPI:1407957632
Name:KIRK, KECIA K (MD)
Entity type:Individual
Prefix:
First Name:KECIA
Middle Name:K
Last Name:KIRK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1397 BELK BLVD
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:MS
Mailing Address - Zip Code:38655-5301
Mailing Address - Country:US
Mailing Address - Phone:662-236-4675
Mailing Address - Fax:662-281-0819
Practice Address - Street 1:1397 BELK BLVD
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:MS
Practice Address - Zip Code:38655-5301
Practice Address - Country:US
Practice Address - Phone:662-236-4675
Practice Address - Fax:662-281-0819
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2010-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS18421207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSP00463813OtherRAILROAD MEDICARE
MS302I083544Medicare PIN
MSP00463813OtherRAILROAD MEDICARE