Provider Demographics
NPI:1598585101
Name:KIRK, MICHELLE LYNN (NMD)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:LYNN
Last Name:KIRK
Suffix:
Gender:F
Credentials:NMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4518 E OLIVE AVE
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85234-7606
Mailing Address - Country:US
Mailing Address - Phone:432-889-6526
Mailing Address - Fax:
Practice Address - Street 1:10153 E HAMPTON AVE STE 104
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85209-3326
Practice Address - Country:US
Practice Address - Phone:480-535-5688
Practice Address - Fax:888-866-6737
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-16
Last Update Date:2024-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Single Specialty