MEDICARE: KATIE KIRKBRIDE

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	174N00000X	Lactation Consultant (Non-RN)	L-317391	CA

General Provider Information

NPI Number	:	1932059482
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATIE KIRKBRIDE

Provider Business Mailing Address
First Line	:	6433 MALVEY AVE
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76116-4422
Country	:	US
Telephone Number	:	805-680-3238
Fax Number	:

Provider Business Practice Location Address
First Line	:	6433 MALVEY AVE
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76116-4422
Country	:	US
Telephone Number	:	805-680-3238
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/02/2026
Last Update Date	:	02/02/2026

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Directions to “ KATIE KIRKBRIDE ” Practice Location

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