Provider Demographics
NPI:1699150862
Name:STALKER-KIRK, KATHRYN JEMEAL (CHA I)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:JEMEAL
Last Name:STALKER-KIRK
Suffix:
Gender:F
Credentials:CHA I
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:
Other - Last Name:KIRK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 256
Mailing Address - Street 2:
Mailing Address - City:KOTZEBUE
Mailing Address - State:AK
Mailing Address - Zip Code:99752-0256
Mailing Address - Country:US
Mailing Address - Phone:907-442-3321
Mailing Address - Fax:
Practice Address - Street 1:1729 QALGI AVE.
Practice Address - Street 2:
Practice Address - City:POINT HOPE
Practice Address - State:AK
Practice Address - Zip Code:99766-0049
Practice Address - Country:US
Practice Address - Phone:907-368-2234
Practice Address - Fax:907-368-2569
Is Sole Proprietor?:No
Enumeration Date:2015-07-29
Last Update Date:2015-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker