Provider Demographics
NPI:1497145403
Name:KIRK, HANNAH P (PA-C)
Entity type:Individual
Prefix:
First Name:HANNAH
Middle Name:P
Last Name:KIRK
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 632476
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-2476
Mailing Address - Country:US
Mailing Address - Phone:423-237-6900
Mailing Address - Fax:423-636-2751
Practice Address - Street 1:1021 COOLIDGE ST STE 4
Practice Address - Street 2:
Practice Address - City:GREENEVILLE
Practice Address - State:TN
Practice Address - Zip Code:37743-5986
Practice Address - Country:US
Practice Address - Phone:423-237-6900
Practice Address - Fax:423-636-2751
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-28
Last Update Date:2025-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2731363A00000X
363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ14561Medicaid