=====================================================
General NPI Number Information
=====================================================
NPI Number | 1649730490
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DORTHEA MORNET KIRBY SF
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/20/2019
-----------------------------------------------------
Last Update Date | 03/20/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3090 BASSETT HEIGHTS ROAD EXT
-----------------------------------------------------
City | BASSETT
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 24055-4812
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 276-252-1043
-----------------------------------------------------
Fax | 276-293-1178
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3090 BASSETT HEIGHTS ROAD EXT
-----------------------------------------------------
City | BASSETT
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 24055-4812
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 276-252-1043
-----------------------------------------------------
Fax | 276-293-1178
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 385H00000X
-----------------------------------------------------
Taxonomy Name | Respite Care
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------