Provider Demographics
NPI:1194033811
Name:KIRBY, CARA WHITE
Entity Type:Individual
Prefix:
First Name:CARA
Middle Name:WHITE
Last Name:KIRBY
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 1:253 RUIN CREEK RD
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NC
Mailing Address - Zip Code:27536-5916
Mailing Address - Country:US
Mailing Address - Phone:252-213-2297
Mailing Address - Fax:252-433-4649
Practice Address - Street 1:253 RUIN CREEK RD
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NC
Practice Address - Zip Code:27536-5916
Practice Address - Country:US
Practice Address - Phone:252-213-2297
Practice Address - Fax:252-433-4649
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-15
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC02741332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1720191661Medicaid
0806240001Medicare PIN