Provider Demographics
NPI:1306854989
Name:KIRBY, PAMELA M (PSY D)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:M
Last Name:KIRBY
Suffix:
Gender:F
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 10024
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79116-0024
Mailing Address - Country:US
Mailing Address - Phone:806-468-7980
Mailing Address - Fax:806-468-7987
Practice Address - Street 1:1208 WOLFLIN AVE
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79109-2252
Practice Address - Country:US
Practice Address - Phone:806-468-7980
Practice Address - Fax:806-468-7987
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX30796103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0056GDOtherBCBS
TXS67915Medicare UPIN
TX00382EMedicare ID - Type Unspecified