Provider Demographics
NPI:1164730495
Name:KIRBY, ZANE ASHTON (PA-C)
Entity Type:Individual
Prefix:
First Name:ZANE
Middle Name:ASHTON
Last Name:KIRBY
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1150 ROBERT BLVD.
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70458-2005
Mailing Address - Country:US
Mailing Address - Phone:985-646-1122
Mailing Address - Fax:888-464-0738
Practice Address - Street 1:1150 ROBERT BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70458-2005
Practice Address - Country:US
Practice Address - Phone:985-646-1122
Practice Address - Fax:888-464-0738
Is Sole Proprietor?:No
Enumeration Date:2010-09-21
Last Update Date:2019-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPA.200384363AM0700X
363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAP00309913OtherRRMCARE THRU PEPA
LA2139002Medicaid
LA2139002Medicaid