Healthcare Provider Details

I. General information

NPI: 1578941423
Provider Name (Legal Business Name): KRISTIN A KIRBY DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2015
Last Update Date: 08/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15419 HODGES CIR STE 200
HUNTERSVILLE NC
28078
US

IV. Provider business mailing address

143 JOE KNOX AVE STE 100
MOORESVILLE NC
28117-9244
US

V. Phone/Fax

Practice location:
  • Phone: 704-892-5575
  • Fax: 704-892-6566
Mailing address:
  • Phone: 704-662-3660
  • Fax: 704-662-3595

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number691
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: