Active NPI
Kelly Kirk, CCP
- Perfusionist
- Lima, OH
National Provider Identifier
1750119889
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Perfusionist
- License
- 000150
- Practice address
- 730 W Market St
Lima, OH 45801-4602 - Phone
- (419) 227-3361
- NPI assigned
- Jul 22, 2024
- 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 |
|---|---|---|---|---|
| Perfusionist | 242T00000X | 000150 | DE | Primary |
Addresses
Primary practice location
730 W Market St
Lima, OH 45801-4602
Mailing address
355 Oak Park St
Summerville, SC 29486-2088
Phone (843) 270-9456
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 000150 | DE | MD | Perfusionist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1721606400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1721606400000",
"number": "1750119889",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "355 OAK PARK ST",
"city": "SUMMERVILLE",
"state": "SC",
"postal_code": "294862088",
"telephone_number": "843-270-9456"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "730 W MARKET ST",
"city": "LIMA",
"state": "OH",
"postal_code": "458014602",
"telephone_number": "419-227-3361"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIRK",
"first_name": "KELLY",
"credential": "CCP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2024-07-22",
"last_updated": "2024-07-22",
"certification_date": "2024-07-22",
"status": "A"
},
"taxonomies": [
{
"code": "242T00000X",
"taxonomy_group": "",
"desc": "Perfusionist",
"state": "DE",
"license": "000150",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lima, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.