MR. JOHNNY MARK KIRK (NPI# 1407979958) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1407979958 |
| Entity Type | Individual |
| Full Name | MR. JOHNNY MARK KIRK |
| Credential | LADC |
| Practice Address |
3604 N Cincinnati Tulsa OK 74106-1536 |
| Mailing Address |
650 S Peoria Tulsa OK 74120-4429 |
| Practice Telephone | 9184254200 |
| Practice Fax Number | 9184254202 |
| Mailing Telephone | 9185879471 |
| Mailing Fax Number | 9185600137 |
| Enumeration Date | 2007-04-09 |
| Last Update Date | 2007-07-08 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 101YM0800X |
Counselor Specialization: Mental Health |
582 | OK | Behavioral Health & Social Service Providers |
| Street Address |
3604 N CINCINNATI |
| City | TULSA |
| State | OK |
| Zip Code | 74106-1536 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629110242 | Laura Ann Patterson | Case Manager/Care Coordinator | 3604 N Cincinnati, Tulsa, OK 74106-1536 | 2007-02-12 |
| 1255539466 | Mavie Jean Busboom | Case Manager/Care Coordinator | 3604 N Cincinnati, Tulsa, OK 74106-1536 | 2007-07-10 |
| 1376746602 | Haley Marie Brooner | Case Manager/Care Coordinator | 3604 N Cincinnati, Tulsa, OK 74106-1536 | 2007-06-06 |
| 1841417557 | Robin Williams | Case Manager/Care Coordinator | 3604 N Cincinnati, Tulsa, OK 74106-1536 | 2007-04-20 |
| 1407985013 | Stayce Lavon Williams | Case Manager/Care Coordinator | 3604 N Cincinnati, Tulsa, OK 74106-1536 | 2007-03-02 |
| 1780719120 | Thomas Glenn Hawthorn | Case Manager/Care Coordinator | 3604 N Cincinnati, Tulsa, OK 74106-1536 | 2007-02-23 |
| 1730222910 | Katherine Michelene Bazin | Counselor | 3604 N Cincinnati, Tulsa, OK 94106-1536 | 2007-02-15 |
| 1336281955 | Ann Rose Brandon | Case Manager/Care Coordinator | 3604 N Cincinnati, Tulsa, OK 74106-1536 | 2007-02-12 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1811538895 | Desma Johnson | Technician | 784 East 43rd Street North, Tulsa, OK 74106 | 2019-10-01 |
| 1912462094 | Breyan Lashawn Jackson | Case Manager/Care Coordinator | 3606 N Mlk Jr. Blvd, Tulsa, OK 74106 | 2019-02-04 |
| 1740751445 | Ernest Kaara Maina | Family Medicine | 3606 M.l.k. Jr Blvd, Tulsa, OK 74106 | 2018-12-07 |
| 1568969632 | A&m Healthcare Clinic | Nurse Practitioner | 3606 North Mlk Blvd, Tulsa, OK 74106 | 2018-04-06 |
| 1265880819 | Paula Patricia Tullis | Psychologist | 1232 N Boston, Tulsa, OK 74106 | 2016-05-24 |
| 1326413030 | Eartha Mcalester | Counselor | 628 E. Virgin St., Tulsa, OK 74106 | 2015-12-07 |
| 1114334182 | James O Brannon Jr. | Behavioral Analyst | 2745 North Main, Tulsa, OK 74106 | 2014-07-22 |
| 1952718512 | Teresa Marie Williams | Counselor | 3601 N. Martin Luther King Blvd, Tulsa, OK 74106 | 2014-07-16 |
| 1639580764 | Lynnette Dixon | Case Management | 708 East 38th Street North, Tulsa, OK 74106 | 2014-05-12 |
| 1184975898 | Tiara Delonia | Social Worker | 1 W 36th St N Suite 1, Tulsa, OK 74106 | 2012-09-21 |
| Find all providers in zip 74106 | ||||
| Taxonomy Code | 101YM0800X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| Specialization | Mental Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881292464 | Sara Saxman | Counselor | 7829 S Yale Ave Apt A, Tulsa, OK 74136-9051 | 2020-10-15 |
| 1881207306 | Jennifer Mcdonald | Counselor | 9804 E 21st Pl Apt A, Tulsa, OK 74129-3815 | 2020-08-25 |
| 1053932905 | Suzanne Schneider | Counselor | 1507 E 21st St, Tulsa, OK 74114-1339 | 2020-05-01 |
| 1396371167 | Amy Lynn Herrold | Counselor | 8211 E Regal Pl, Tulsa, OK 74133-7167 | 2020-03-12 |
| 1033758453 | Anew Dawn Counseling Services LLC | Counselor | 2227 S Garnett Rd Ste 106, Tulsa, OK 74129-5115 | 2020-01-02 |
| 1679111231 | Shandeisha N Hay | Counselor | 6131 S Yorktown Ave Apt 1, Tulsa, OK 74136-0936 | 2019-12-13 |
| 1699320119 | Grace Oluloto | Counselor | 2740 E 41st St N, Tulsa, OK 74110-1432 | 2019-08-02 |
| 1467005900 | Courtney Gillespie | Counselor | 8810 S Yale Ave Ste K, Tulsa, OK 74137-3551 | 2019-07-23 |
| 1922660661 | Katherine Marie Nash | Counselor | 5072 S Toledo Ave Apt 23c, Tulsa, OK 74135-3350 | 2019-07-02 |
| 1205493590 | Wright Choice Counseling Services, LLC | Counselor | 6130 E 32nd St Ste 106, Tulsa, OK 74135-5454 | 2019-05-22 |
| Find all providers in TULSA | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.