Most Relevant Information
Provider Data
| NPI Number: | 1003318726 |
| Provider Name: | LARISSA DYAN KIRK |
| Entity Type: | Individual |
| Taxonomy Code: | 164W00000X |
| Specialty: | Licensed Practical Nurse |
| License Number: | 19572 |
Most Important Dates
| Enumeration Date: | 03/08/2018 |
| Last Updated: | 03/08/2018 |
Provider Practice Location
1631 E 2ND ST
AUSTIN
TX
787024490
Practice Location Phone/Fax
| Phone: | 5124557787 |
| Fax: |
Provider Mailing Location
1430 COLLIER ST
AUSTIN
TX
787042911
Provider Mailing Phone/Fax
| Phone: | 5124724357 |
| Fax: | 5127031394 |