Provider Demographics
NPI:1861262818
Name:KIRKBY, SANDRA MIRIAM (FNP-BC)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:MIRIAM
Last Name:KIRKBY
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1392 W KESLER LN
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-7227
Mailing Address - Country:US
Mailing Address - Phone:480-630-3279
Mailing Address - Fax:
Practice Address - Street 1:1392 W KESLER LN
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-7227
Practice Address - Country:US
Practice Address - Phone:480-630-3279
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-02
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ299869363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily