Healthcare Provider Details

I. General information

NPI: 1124613328
Provider Name (Legal Business Name): CALLIE KIRBY APRN, FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2021
Last Update Date: 02/25/2022
Certification Date: 02/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 MCMAKIN RD
BARTONVILLE TX
76226-8438
US

IV. Provider business mailing address

80 MCMAKIN RD
BARTONVILLE TX
76226-8438
US

V. Phone/Fax

Practice location:
  • Phone: 940-455-7100
  • Fax:
Mailing address:
  • Phone: 940-455-7100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1029184
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: