Provider Demographics
NPI:1043437999
Name:DORSEY, KIBRA (RN)
Entity type:Individual
Prefix:
First Name:KIBRA
Middle Name:
Last Name:DORSEY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2728 SPIRIT CREEK RD
Mailing Address - Street 2:
Mailing Address - City:HEPHZIBAH
Mailing Address - State:GA
Mailing Address - Zip Code:30815-5993
Mailing Address - Country:US
Mailing Address - Phone:706-798-8003
Mailing Address - Fax:706-798-8003
Practice Address - Street 1:2728 SPIRIT CREEK RD
Practice Address - Street 2:
Practice Address - City:HEPHZIBAH
Practice Address - State:GA
Practice Address - Zip Code:30815-5993
Practice Address - Country:US
Practice Address - Phone:706-798-8003
Practice Address - Fax:706-798-8003
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN182066163WC0200X
CA709730163WC0200X
FLRN9197155163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine