Active NPI
Courtney Dyan Kirk
- Developmental Therapist
- Decatur, IL
National Provider Identifier
1295063881
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Developmental Therapist
- Practice address
- 4815 N Martin Luther King Jr Dr
Apt 112
Decatur, IL 62526-6127 - Phone
- (217) 412-1422
- NPI assigned
- Nov 20, 2009
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Developmental Therapist | 222Q00000X | Primary |
Addresses
Primary practice location
4815 N Martin Luther King Jr Dr
Apt 112
Decatur, IL 62526-6127
Mailing address
4815 N Martin Luther King Jr. Dr.
Apt 112
Decatur, IL 62526
Phone (217) 412-1422
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1258675200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1258675200000",
"number": "1295063881",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4815 N MARTIN LUTHER KING JR. DR.",
"address_2": "APT 112",
"city": "DECATUR",
"state": "IL",
"postal_code": "62526",
"telephone_number": "217-412-1422"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4815 N MARTIN LUTHER KING JR DR",
"address_2": "APT 112",
"city": "DECATUR",
"state": "IL",
"postal_code": "625266127",
"telephone_number": "217-412-1422"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIRK",
"first_name": "COURTNEY",
"middle_name": "DYAN",
"name_prefix": "Ms.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2009-11-20",
"last_updated": "2009-11-20",
"status": "A"
},
"taxonomies": [
{
"code": "222Q00000X",
"taxonomy_group": "",
"desc": "Developmental Therapist",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Decatur, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 20, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.