Healthcare Provider Details

I. General information

NPI: 1164584785
Provider Name (Legal Business Name): KIM KIRBY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/14/2006
Last Update Date: 07/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

212 CALEF HWY
EPPING NH
03042-2322
US

IV. Provider business mailing address

7 HOLLAND WAY FL 1
EXETER NH
03833-2997
US

V. Phone/Fax

Practice location:
  • Phone: 603-693-2100
  • Fax: 603-679-1046
Mailing address:
  • Phone: 603-693-2100
  • Fax: 603-679-1046

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number168256
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number035757-23
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: