Healthcare Provider Details

I. General information

NPI: 1972208205
Provider Name (Legal Business Name): KIRBY KLEPACKI PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KIRBY HEFFRIN PA

II. Dates (important events)

Enumeration Date: 04/04/2023
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3535 OLENTANGY RIVER RD
COLUMBUS OH
43214-3908
US

IV. Provider business mailing address

PO BOX 7527
DUBLIN OH
43017-0727
US

V. Phone/Fax

Practice location:
  • Phone: 614-566-5000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50.009395RX
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: