Provider Demographics
NPI:1699579284
Name:KIRK, TERI NICOLE
Entity type:Individual
Prefix:
First Name:TERI
Middle Name:NICOLE
Last Name:KIRK
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11011 Q ST STE 101C
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68137-3700
Mailing Address - Country:US
Mailing Address - Phone:402-697-5121
Mailing Address - Fax:
Practice Address - Street 1:108 4TH AVE
Practice Address - Street 2:
Practice Address - City:UNDERWOOD
Practice Address - State:IA
Practice Address - Zip Code:51576-4902
Practice Address - Country:US
Practice Address - Phone:712-308-2217
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-02
Last Update Date:2025-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion
No372500000XNursing Service Related ProvidersChore Provider
No374U00000XNursing Service Related ProvidersHome Health Aide