Provider Demographics
NPI:1336023951
Name:PHILLIPS, KIRK MICHAEL (CNA, CMA)
Entity type:Individual
Prefix:
First Name:KIRK
Middle Name:MICHAEL
Last Name:PHILLIPS
Suffix:
Gender:M
Credentials:CNA, CMA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 N 35TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68131-2425
Mailing Address - Country:US
Mailing Address - Phone:531-203-9393
Mailing Address - Fax:
Practice Address - Street 1:135 N 35TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68131-2425
Practice Address - Country:US
Practice Address - Phone:531-203-9393
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-05
Last Update Date:2025-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide