Active NPI
Raeanna Kirk, RN
- Child & Adolescent Psychiatric/Mental Health Registered Nurse
- Draper, UT
National Provider Identifier
1124096417
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Child & Adolescent Psychiatric/Mental Health Registered Nurse
- License
- 3082894-3102
- Practice address
- 11706 S 700 E
Draper, UT 84020-9365 - Phone
- (801) 963-4200
- NPI assigned
- Mar 10, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Child & Adolescent Psychiatric/Mental Health Registered Nurse | 163WP0807X | 3082894-3102 | UT | Primary |
Addresses
Primary practice location
11706 S 700 E
Draper, UT 84020-9365
Mailing address
11706 S 700 E
Draper, UT 84020-9365
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3082894-3102 | UT | MD | Child & Adolescent Psychiatric/Mental Health Registered Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1141948800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1275955200000",
"number": "1124096417",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11706 S 700 E",
"city": "DRAPER",
"state": "UT",
"postal_code": "840209365"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11706 S 700 E",
"city": "DRAPER",
"state": "UT",
"postal_code": "840209365",
"telephone_number": "801-963-4200"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIRK",
"first_name": "RAEANNA",
"name_prefix": "Mrs.",
"credential": "RN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-03-10",
"last_updated": "2010-06-08",
"status": "A"
},
"taxonomies": [
{
"code": "163WP0807X",
"taxonomy_group": "",
"desc": "Registered Nurse, Psychiatric/Mental Health, Child & Adolescent",
"state": "UT",
"license": "3082894-3102",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Draper, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 8, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.