NPIMap

Organization Active NPI

Donna M Van Kirk Edd PLLC

  • Psychologist
  • Fayetteville, AR
National Provider Identifier
1659737575
Registry record updated Jan 7, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
82-P10 Issued in AR
Legal business name
DONNA M VAN KIRK EDD PLLC
Practice address
204 N East Ave
Fayetteville, AR 72701-5225
Phone
(479) 466-9609
Fax
(479) 442-5587
NPI assigned
Jan 7, 2016
Last updated
Jan 7, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 7, 2016

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

Authorized official

Name
Dr. Donna M Van Kirk, EDDNPI 1235167578
Title
Psychologist
Phone
(479) 466-9609

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X 82-P10 AR Primary

Addresses

Primary practice location

204 N East Ave
Fayetteville, AR 72701-5225

Mailing address

31 S Kestrel Dr
Fayetteville, AR 72701-1322
Phone (479) 466-9609

Other identifiers 1

IdentifierTypeStateIssuer
116603719MedicaidAR

National Provider Directory

National Provider Directory

Locations

204 N East Ave
Fayetteville, AR 72701
Phone (479) 442-0763

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1452124800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1452124800000",
    "number": "1659737575",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "31 S KESTREL DR",
            "city": "FAYETTEVILLE",
            "state": "AR",
            "postal_code": "727011322",
            "telephone_number": "479-466-9609",
            "fax_number": "479-442-5587"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "204 N EAST AVE",
            "city": "FAYETTEVILLE",
            "state": "AR",
            "postal_code": "727015225",
            "telephone_number": "479-466-9609",
            "fax_number": "479-442-5587"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DONNA M VAN KIRK EDD PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-01-07",
        "last_updated": "2016-01-07",
        "status": "A",
        "authorized_official_last_name": "VAN KIRK",
        "authorized_official_first_name": "DONNA",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "PSYCHOLOGIST",
        "authorized_official_telephone_number": "479-466-9609",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "EDD"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "AR",
            "license": "82-P10",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "116603719",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fayetteville, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 7, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.