Provider Demographics
NPI:1093105421
Name:KIRBY, LAVERN
Entity Type:Individual
Prefix:
First Name:LAVERN
Middle Name:
Last Name:KIRBY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6008 WESTCREEK DR APT A
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78749-4628
Mailing Address - Country:US
Mailing Address - Phone:512-679-1517
Mailing Address - Fax:512-928-4243
Practice Address - Street 1:6008 WESTCREEK DR APT A
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78749-4628
Practice Address - Country:US
Practice Address - Phone:512-679-1517
Practice Address - Fax:512-928-4243
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-22
Last Update Date:2015-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343800000XTransportation ServicesSecured Medical Transport (VAN)