Provider Demographics
NPI:1245103084
Name:KIRK, TARIA Q
Entity type:Individual
Prefix:
First Name:TARIA
Middle Name:Q
Last Name:KIRK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:371 PRAIRIEWOOD CIR S APT 206
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-4661
Mailing Address - Country:US
Mailing Address - Phone:762-744-3264
Mailing Address - Fax:
Practice Address - Street 1:371 PRAIRIEWOOD CIR S APT 206
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-4661
Practice Address - Country:US
Practice Address - Phone:762-744-3264
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-26
Last Update Date:2025-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172V00000XOther Service ProvidersCommunity Health WorkerGroup - Single Specialty