Provider Demographics
NPI:1891687869
Name:KIRK, KATELYN NICOLE
Entity type:Individual
Prefix:
First Name:KATELYN
Middle Name:NICOLE
Last Name:KIRK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:807 ASHLAND TER NE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37312-5104
Mailing Address - Country:US
Mailing Address - Phone:423-599-3716
Mailing Address - Fax:
Practice Address - Street 1:55 25TH ST NW STE 210
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37311-3958
Practice Address - Country:US
Practice Address - Phone:615-444-0597
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-16
Last Update Date:2025-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRBT-25-417656106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician