William D. Kirk M.D., PLLC

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

26011 Issued in KY

Legal business name

WILLIAM D. KIRK M.D., PLLC

Practice address

312 W High St
Lebanon, KY 40033-1428

Phone

(270) 692-9559

Fax

(270) 692-9236

NPI assigned

Oct 5, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. William Deadrick Kirk, M.D.NPI 1972595270

Title

Owner

Phone

(270) 692-9559

Specialties & licenses 4

Addresses

Other identifiers 4

Medicare fee-for-service enrollment

Enrolled in KY

Enrollment records 1

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• William Deadrick Kirk, M.D.

  • Internal Medicine Physician
  • Lebanon, KY
  • NPI 1972595270
  Medicare reassignment Care Compare group NPD Authorized official
• Abigail Porter, APRN

  • Family Nurse Practitioner
  • Lebanon, KY
  • NPI 1053020651
  Medicare reassignment Care Compare group NPD
• Abigail Hagan Southall, NURSE PRACTITIONER

  • Family Nurse Practitioner
  • Lebanon, KY
  • NPI 1861006066
  Medicare reassignment Care Compare group NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1160006400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1444089600000",
    "number": "1417043886",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "312 W HIGH ST",
            "city": "LEBANON",
            "state": "KY",
            "postal_code": "400331428",
            "telephone_number": "270-692-9559",
            "fax_number": "270-692-9236"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "312 W HIGH ST",
            "city": "LEBANON",
            "state": "KY",
            "postal_code": "400331428",
            "telephone_number": "270-692-9559",
            "fax_number": "270-692-9236"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILLIAM D. KIRK M.D., PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-05",
        "last_updated": "2015-10-06",
        "status": "A",
        "authorized_official_last_name": "KIRK",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_middle_name": "DEADRICK",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "270-692-9559",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": "KY",
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "KY",
            "license": "26011",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "KY",
            "license": "26011",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": "KY",
            "license": "26011",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9590111200",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PASSPORT",
            "identifier": "50001390",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PASSPORT ADVANTAGE",
            "identifier": "2442987001",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "78903242",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Christa D Walters, APRN
• Stephanie Watson
• Brian Wayne Wentz, D.C.
• Michael Jared Wheatley, ATC
• Deadra Jeanna Wiegel, PTA
• William Duley III
• Vicki Williams, LCSW
• Tanner Bryce Wilson, PT, DPT
• Hope Hagan Winebrenner, RPH
• Christie Darlene Witham, MHA

• Family Nurse Practitioner in Lebanon, KY
• Providers in Lebanon, KY by specialty
• Family Nurse Practitioner in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 6, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.