| Doctor Name: | MRS. RAEANNA KIRK |
| NPI Number: | 1124096417 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | RN |
| License Number: | 3082894-3102 |
| Business Practice Address: | 11706 S 700 E Draper, UT - 840209365 |
| Business Phone Number: | 8019634200 |
| Business Fax Number: | |
| Mailing Address: | 11706 S 700 E, DRAPER |
| State: | UT |
| Postal Code: | 840209365 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 03/10/2006 |
| NPI Last Update Date: | 06/08/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 163WP0807X |
| License Number: | 3082894-3102 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | UT |
| Taxonomy Type: | Nursing Service Providers |
| Taxonomy Classification: | Registered Nurse |
| Taxonomy Specialization: | Psych/Mental Health, Child & Adolescent |
| Taxonomy Definition: | |