Healthcare Provider Details

I. General information

NPI: 1114242286
Provider Name (Legal Business Name): CAROLYN KIRKBRIDE FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/01/2010
Last Update Date: 04/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 W BROAD ST
RICHMOND VA
23284-9089
US

IV. Provider business mailing address

1300 W BROAD ST
RICHMOND VA
23284-9089
US

V. Phone/Fax

Practice location:
  • Phone: 804-828-8828
  • Fax:
Mailing address:
  • Phone: 804-828-8828
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024168725
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: