Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | 9074A | WY |
NPI | 1003078148 |
---|---|
Provider Name | Dr. Kristine K Van Kirk |
First Address | Cheyenne, WY 82009-4347 |
Second Address | Cheyenne, WY 82009-4347 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/06/2008 |
Last Update Date | 03/01/2019 |