MEDICARE: KIRBY HEALTH CARE, P. C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261Q00000X	Clinic/Center
2	363LF0000X	Family Nurse Practitioner	0330	SD

General Provider Information

NPI Number	:	1043354319
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KIRBY HEALTH CARE, P. C.

Provider Business Mailing Address
First Line	:	1501 CENTRE ST STE 102
Second Line	:
City	:	RAPID CITY
State	:	SD
Zip	:	57703-3004
Country	:	US
Telephone Number	:	605-343-3007
Fax Number	:	605-343-3007

Provider Business Practice Location Address
First Line	:	1501 CENTRE ST STE 102
Second Line	:
City	:	RAPID CITY
State	:	SD
Zip	:	57703-3004
Country	:	US
Telephone Number	:	605-484-9775
Fax Number	:	605-343-3007

Authorized Official
Title or Position	:	OWNER
Name	:	MS. PAULETTE ANGELA KIRBY
Credential	:	CNP
Telephone Number	:	605-484-9775

Provider Enumeration Date	:	02/19/2007
Last Update Date	:	12/01/2021

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