Healthcare Provider Details

I. General information

NPI: 1396101705
Provider Name (Legal Business Name): AGNES CLARISSA KIRBY RN BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/14/2016
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6424 18TH AVE FL 2
BROOKLYN NY
11204-3729
US

IV. Provider business mailing address

4040 S EASTERN AVE STE 300
LAS VEGAS NV
89119-0854
US

V. Phone/Fax

Practice location:
  • Phone: 702-463-0300
  • Fax:
Mailing address:
  • Phone: 702-463-0300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number847340
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number940937
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: