Provider Demographics
NPI:1225804321
Name:KIRBY, COURTNEY T
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:T
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 1:2350 BRASHEARS ST
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70807-4405
Mailing Address - Country:US
Mailing Address - Phone:225-454-2664
Mailing Address - Fax:
Practice Address - Street 1:2350 BRASHEARS ST
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70807-4405
Practice Address - Country:US
Practice Address - Phone:225-454-2664
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-29
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor