Provider Demographics
NPI:1871555300
Name:BARRON, KIRK W (PA)
Entity type:Individual
Prefix:
First Name:KIRK
Middle Name:W
Last Name:BARRON
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1250 8TH AVE
Mailing Address - Street 2:SUITE 135
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104
Mailing Address - Country:US
Mailing Address - Phone:817-332-8848
Mailing Address - Fax:817-335-2670
Practice Address - Street 1:1250 8TH AVE
Practice Address - Street 2:SUITE 135
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104
Practice Address - Country:US
Practice Address - Phone:817-332-8848
Practice Address - Fax:817-335-2670
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-03
Last Update Date:2012-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA04583363AS0400X, 363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP00784417OtherRAILROAD MEDICARE
TX194565101Medicaid
TX8Y8718OtherBCBS
8D9366Medicare UPIN
TX8Y8718OtherBCBS
TXP55549Medicare UPIN