Provider Demographics
NPI:1184945198
Name:KING, NICOLE RENAE KIRBY (MD)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:RENAE KIRBY
Last Name:KING
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 SOUTHFIELD DR
Mailing Address - Street 2:SUITE 1370
Mailing Address - City:PLAINFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46168-4498
Mailing Address - Country:US
Mailing Address - Phone:317-837-5571
Mailing Address - Fax:
Practice Address - Street 1:112 HOSPITAL LN
Practice Address - Street 2:SUITE 200
Practice Address - City:DANVILLE
Practice Address - State:IN
Practice Address - Zip Code:46122-1977
Practice Address - Country:US
Practice Address - Phone:317-745-3366
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-14
Last Update Date:2021-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN11015672A390200000X
IN01074094A207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program