Healthcare Provider Details

I. General information

NPI: 1083551220
Provider Name (Legal Business Name): AUSTIN KIRBY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2026
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

473 SUMNER AVE
SPRINGFIELD MA
01108-2321
US

IV. Provider business mailing address

19 LOCKHOUSE RD APT 14-1
WESTFIELD MA
01085-1275
US

V. Phone/Fax

Practice location:
  • Phone: 413-739-1100
  • Fax: 413-735-1133
Mailing address:
  • Phone: 413-739-1100
  • Fax: 413-735-1133

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License NumberRN2347450
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: