Provider Demographics
NPI:1760873079
Name:KIRBY, KURSULA (KURSULA KIRBY, MPH)
Entity Type:Individual
Prefix:MISS
First Name:KURSULA
Middle Name:
Last Name:KIRBY
Suffix:
Gender:F
Credentials:KURSULA KIRBY, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 W HIGHLAND ST LOT 227
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33815-4293
Mailing Address - Country:US
Mailing Address - Phone:863-617-2314
Mailing Address - Fax:
Practice Address - Street 1:122 E MAIN ST # 111
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33801-4655
Practice Address - Country:US
Practice Address - Phone:813-703-0533
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-09
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171400000X, 171M00000X, 172V00000X, 174H00000X, 224P00000X, 372500000X, 374U00000X, 376K00000X, 133NN1002X
FLCNA488504372600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
No171400000XOther Service ProvidersHealth & Wellness Coach
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No172V00000XOther Service ProvidersCommunity Health Worker
No174H00000XOther Service ProvidersHealth Educator
No224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
No372500000XNursing Service Related ProvidersChore Provider
No372600000XNursing Service Related ProvidersAdult Companion
No374U00000XNursing Service Related ProvidersHome Health Aide
No376K00000XNursing Service Related ProvidersNurse's Aide