Provider Demographics
NPI:1033189790
Name:KIRBY, PAULETTE A (FNP)
Entity Type:Individual
Prefix:
First Name:PAULETTE
Middle Name:A
Last Name:KIRBY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22755 SILVER CITY RD
Mailing Address - Street 2:
Mailing Address - City:SILVER CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57702-6040
Mailing Address - Country:US
Mailing Address - Phone:605-342-3613
Mailing Address - Fax:
Practice Address - Street 1:811 COLUMBUS ST
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701-3540
Practice Address - Country:US
Practice Address - Phone:605-343-3007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDR024388363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
44624OtherSIOUX VALLEY HEALTH PLAN
SD4995122OtherBCBS SD (WELLMARK)
01-19363OtherMEDICA
132685OtherUCARE
SD6826213Medicaid
SD6826214Medicaid
MN693G1KIOtherBCBS MN
1042921OtherPREFERRED ONE
2315537OtherAMERICA'S PPO (ARAZ)
44624OtherSIOUX VALLEY HEALTH PLAN
SD6826214Medicaid