Provider Demographics
NPI:1730846668
Name:KIRK, ANDRE FELIX JR (YOGA INSTRUCTOR TRAI)
Entity type:Individual
Prefix:MR
First Name:ANDRE
Middle Name:FELIX
Last Name:KIRK
Suffix:JR
Gender:M
Credentials:YOGA INSTRUCTOR TRAI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1951 W 97TH PL
Mailing Address - Street 2:
Mailing Address - City:CROWN POINT
Mailing Address - State:IN
Mailing Address - Zip Code:46307-2351
Mailing Address - Country:US
Mailing Address - Phone:219-256-1677
Mailing Address - Fax:219-663-0279
Practice Address - Street 1:1951 W 97TH PL
Practice Address - Street 2:
Practice Address - City:CROWN POINT
Practice Address - State:IN
Practice Address - Zip Code:46307-2351
Practice Address - Country:US
Practice Address - Phone:219-256-1677
Practice Address - Fax:219-663-0279
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-27
Last Update Date:2021-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty