Healthcare Provider Details

I. General information

NPI: 1811788805
Provider Name (Legal Business Name): KALEB MICHAEL KIRBY DNP APRN FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2025
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 EAST HOSPITAL ROAD
FORT GORDON GA
30905
US

IV. Provider business mailing address

300 EAST HOSPITAL ROAD
FORT GORDON GA
30905
US

V. Phone/Fax

Practice location:
  • Phone: 706-787-2055
  • Fax:
Mailing address:
  • Phone: 706-787-2055
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number202402
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: