Provider Demographics
NPI:1679851059
Name:IRBY, KENNETH DEAN (FNP-C)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:DEAN
Last Name:IRBY
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2962 RUSTIC PIER LN
Mailing Address - Street 2:
Mailing Address - City:LEAGUE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77573-6378
Mailing Address - Country:US
Mailing Address - Phone:318-518-1017
Mailing Address - Fax:866-702-5595
Practice Address - Street 1:5865 RIDEWAY CENTER PARKWAY
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38120-3812
Practice Address - Country:US
Practice Address - Phone:337-991-9276
Practice Address - Fax:337-943-0846
Is Sole Proprietor?:No
Enumeration Date:2011-08-02
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP136104363LF0000X
LAAP06627363LF0000X
TN28855363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily