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General NPI Number Information
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NPI Number | 1477045714
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Entity Type | Individual
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Provider Name | JACQUELINE KIRBY
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Gender | Female
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Dates
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Enumeration Date | 06/02/2018
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Last Update Date | 06/02/2018
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Provider Practice Location Address
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Address Line | 5212 FOX HUNT DR APT A
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City | GREENSBORO
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State | NC
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Zip | 27407-7118
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Country | US
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Telephone | 336-541-4545
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Fax |
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Provider Business Mailing Address
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Address Line | 1509 GUINNESS DR
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City | MC LEANSVILLE
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State | NC
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Zip | 27301-9512
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Country | US
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Telephone | 336-541-4545
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
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License Number |
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License Number State |
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