Provider Demographics
NPI:1679339915
Name:KIRBY, ANNA SANDRA
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:SANDRA
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 1:520 N STAPLEY DR UNIT 119
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85203-7255
Mailing Address - Country:US
Mailing Address - Phone:480-206-3940
Mailing Address - Fax:
Practice Address - Street 1:1201 S 7TH AVE STE 150
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85007-4075
Practice Address - Country:US
Practice Address - Phone:480-206-4936
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-26
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ302567363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health