Provider Demographics
NPI:1154644870
Name:KIRBY, ANN (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:
Last Name:KIRBY
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:ANN
Other - Middle Name:M
Other - Last Name:DALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11 S DIVISION ST STE A
Mailing Address - Street 2:
Mailing Address - City:BONNE TERRE
Mailing Address - State:MO
Mailing Address - Zip Code:63628-1701
Mailing Address - Country:US
Mailing Address - Phone:573-723-1100
Mailing Address - Fax:573-723-1130
Practice Address - Street 1:11 S DIVISION ST STE A
Practice Address - Street 2:
Practice Address - City:BONNE TERRE
Practice Address - State:MO
Practice Address - Zip Code:63628-1701
Practice Address - Country:US
Practice Address - Phone:573-723-1100
Practice Address - Fax:573-723-1130
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-09
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010006113363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health