Provider Demographics
NPI:1629188826
Name:KIRBY, DIANA L (FNP-BC)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:L
Last Name:KIRBY
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2370 CORPORATE CIR STE 300
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89074-7760
Mailing Address - Country:US
Mailing Address - Phone:702-910-3950
Mailing Address - Fax:702-778-2264
Practice Address - Street 1:9065 S PECOS RD STE 190
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89074-6605
Practice Address - Country:US
Practice Address - Phone:702-888-3148
Practice Address - Fax:702-888-3158
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2019-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVAPRN001606363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1629188826Medicaid
NE097426Medicare PIN
NEP78675Medicare UPIN
NE276253Medicare PIN
NV1629188826Medicaid
NE500029479Medicare PIN