Provider Demographics
NPI:1184718710
Name:KIRK, GINA R (ACNP)
Entity type:Individual
Prefix:
First Name:GINA
Middle Name:R
Last Name:KIRK
Suffix:
Gender:F
Credentials:ACNP
Other - Prefix:
Other - First Name:GINA
Other - Middle Name:R
Other - Last Name:PHEGLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ACNP
Mailing Address - Street 1:1100 SOUTHFIELD DR
Mailing Address - Street 2:SUITE 1370
Mailing Address - City:PLAINFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46168-4498
Mailing Address - Country:US
Mailing Address - Phone:317-837-5571
Mailing Address - Fax:317-837-5580
Practice Address - Street 1:1000 E MAIN ST
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:IN
Practice Address - Zip Code:46122
Practice Address - Country:US
Practice Address - Phone:317-718-4740
Practice Address - Fax:317-718-6740
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2013-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71001994A363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care