Provider Demographics
NPI:1013021690
Name:KITCHENS, KIRBY (CRNA)
Entity Type:Individual
Prefix:
First Name:KIRBY
Middle Name:
Last Name:KITCHENS
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2311 W DOUBLEGATE DR
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31721-9254
Mailing Address - Country:US
Mailing Address - Phone:229-888-2554
Mailing Address - Fax:229-888-2554
Practice Address - Street 1:2311 W DOUBLEGATE DR
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31721-9254
Practice Address - Country:US
Practice Address - Phone:229-888-2554
Practice Address - Fax:229-888-2554
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2009-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN137510367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q65349Medicare UPIN
GA43BBCCLMedicare ID - Type Unspecified