Healthcare Provider Details

I. General information

NPI: 1770834384
Provider Name (Legal Business Name): KIMBERLY ANNE IRVINE FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2012
Last Update Date: 11/13/2025
Certification Date: 11/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 ROUTE 28
HARWICH PORT MA
02646-1931
US

IV. Provider business mailing address

PO BOX 598
HARWICH PORT MA
02646-0598
US

V. Phone/Fax

Practice location:
  • Phone: 508-432-1400
  • Fax: 508-487-6298
Mailing address:
  • Phone: 508-432-1400
  • Fax: 508-487-6298

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN2282034
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: