Provider Demographics
NPI:1144361692
Name:KIRBY, KRISTEN F (DNP, FNP-BC, CNE)
Entity type:Individual
Prefix:PROF
First Name:KRISTEN
Middle Name:F
Last Name:KIRBY
Suffix:
Gender:F
Credentials:DNP, FNP-BC, CNE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5627 ROSEBERRY RDG
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47905-8507
Mailing Address - Country:US
Mailing Address - Phone:655-860-2507
Mailing Address - Fax:
Practice Address - Street 1:2200 ELMWOOD AVE STE D11
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47904-2391
Practice Address - Country:US
Practice Address - Phone:765-756-5077
Practice Address - Fax:800-810-3955
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2024-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71002901A363LF0000X
IN28152109A363LF0000X, 163WP1700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WP1700XNursing Service ProvidersRegistered NursePerinatal
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200935870Medicaid
IN000000955703OtherANTHEM PROVIDER NUMBER
IN815500106Medicare PIN