Basic Information
Provider Information | |||||||||
NPI: | 1205379047 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | KIRBY | ||||||||
FirstName: | ANDREA | ||||||||
MiddleName: | S | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | CNP | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | PHEIFER | ||||||||
OtherFirstName: | ANDREA | ||||||||
OtherMiddleName: | S | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 5400 FRANTZ RD | ||||||||
Address2: | SUITE 250 | ||||||||
City: | DUBLIN | ||||||||
State: | OH | ||||||||
PostalCode: | 430164144 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6145446382 | ||||||||
FaxNumber: | 6145446370 | ||||||||
Practice Location | |||||||||
Address1: | 3705 OLENTANGY RIVER RD | ||||||||
Address2: | SUITE 100 | ||||||||
City: | COLUMBUS | ||||||||
State: | OH | ||||||||
PostalCode: | 432143467 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6142626772 | ||||||||
FaxNumber: | 6145330161 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 11/28/2016 | ||||||||
LastUpdateDate: | 11/28/2016 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | RN.335227 | OH | Y |   | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.