Provider Demographics
NPI:1184447310
Name:KIRVIN, SKYLAR (MA)
Entity type:Individual
Prefix:
First Name:SKYLAR
Middle Name:
Last Name:KIRVIN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8124 GERANIUM LN
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76123-1898
Mailing Address - Country:US
Mailing Address - Phone:817-683-2010
Mailing Address - Fax:
Practice Address - Street 1:8124 GERANIUM LN
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76123-1898
Practice Address - Country:US
Practice Address - Phone:817-683-2010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-06
Last Update Date:2024-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXNA0008881070376K00000X
TXS9Y8B7Y5363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No376K00000XNursing Service Related ProvidersNurse's Aide