Provider Demographics
NPI:1285834705
Name:KIRBY, CHERYL CATHLEEN (PA)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:CATHLEEN
Last Name:KIRBY
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Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:5401 N PORTLAND
Mailing Address - Street 2:STE 310
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-2082
Mailing Address - Country:US
Mailing Address - Phone:405-951-4160
Mailing Address - Fax:405-951-4162
Practice Address - Street 1:5401 N PORTLAND
Practice Address - Street 2:STE 310
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-2082
Practice Address - Country:US
Practice Address - Phone:405-951-4160
Practice Address - Fax:405-951-4162
Is Sole Proprietor?:No
Enumeration Date:2007-07-23
Last Update Date:2020-09-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OK875363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant