Provider Demographics
NPI:1043354319
Name:KIRBY HEALTH CARE, P. C.
Entity Type:Organization
Organization Name:KIRBY HEALTH CARE, P. C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:PAULETTE
Authorized Official - Middle Name:ANGELA
Authorized Official - Last Name:KIRBY
Authorized Official - Suffix:
Authorized Official - Credentials:CNP
Authorized Official - Phone:605-484-9775
Mailing Address - Street 1:1501 CENTRE ST STE 102
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57703-3004
Mailing Address - Country:US
Mailing Address - Phone:605-343-3007
Mailing Address - Fax:605-343-3007
Practice Address - Street 1:1501 CENTRE ST STE 102
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57703-3004
Practice Address - Country:US
Practice Address - Phone:605-484-9775
Practice Address - Fax:605-343-3007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-19
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261Q00000X
SD0330363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Single Specialty