Provider Demographics
NPI:1578941423
Name:KIRBY, KRISTIN A (DPM)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:A
Last Name:KIRBY
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:143 JOE KNOX AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-9244
Mailing Address - Country:US
Mailing Address - Phone:704-662-3660
Mailing Address - Fax:704-662-3595
Practice Address - Street 1:15419 HODGES CIR STE 200
Practice Address - Street 2:
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078
Practice Address - Country:US
Practice Address - Phone:704-892-5575
Practice Address - Fax:704-892-6566
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-12
Last Update Date:2018-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NC691213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty