Provider Demographics
NPI:1588556682
Name:KIRK, MARIAH (CST, CSFA)
Entity type:Individual
Prefix:
First Name:MARIAH
Middle Name:
Last Name:KIRK
Suffix:
Gender:F
Credentials:CST, CSFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:833 GLOBE AVE
Mailing Address - Street 2:
Mailing Address - City:BLUE MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:76131-1538
Mailing Address - Country:US
Mailing Address - Phone:817-721-0110
Mailing Address - Fax:
Practice Address - Street 1:1650 W COLLEGE ST
Practice Address - Street 2:
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-3565
Practice Address - Country:US
Practice Address - Phone:817-481-1588
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-15
Last Update Date:2025-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program