Provider Demographics
NPI:1265556021
Name:KIRBY, VICKI MARIE (RN, IBCLC)
Entity type:Individual
Prefix:
First Name:VICKI
Middle Name:MARIE
Last Name:KIRBY
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:636 RTE 73
Mailing Address - Street 2:
Mailing Address - City:ORWELL
Mailing Address - State:VT
Mailing Address - Zip Code:05760-9625
Mailing Address - Country:US
Mailing Address - Phone:802-236-4136
Mailing Address - Fax:802-948-2172
Practice Address - Street 1:636 RTE 73
Practice Address - Street 2:
Practice Address - City:ORWELL
Practice Address - State:VT
Practice Address - Zip Code:05760-9625
Practice Address - Country:US
Practice Address - Phone:802-236-4136
Practice Address - Fax:802-948-2172
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2018-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0260020659163WL0100X, 332B00000X
VT260020659163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1010130Medicaid