Provider Demographics
NPI:1699813378
Name:KIRBY, JAMIE ELLEN (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMIE
Middle Name:ELLEN
Last Name:KIRBY
Suffix:
Gender:F
Credentials:MD
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 841656
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-1656
Mailing Address - Country:US
Mailing Address - Phone:903-531-5000
Mailing Address - Fax:
Practice Address - Street 1:5414 S BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75703-1335
Practice Address - Country:US
Practice Address - Phone:903-581-1601
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-02
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0433607207Q00000X
TXP3179207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX302017403Medicaid
TX8EZ110OtherBCBS
TX75-1976930-005OtherTRICARE
TX750818167002OtherTRICARE
TXP01876970OtherMEDICARE RAIL ROAD
TX8DG764OtherBCBS
TX8EZ029OtherBCBS
TX00T71UOtherBCBS BLUE
TX297758YS6VOtherMEDICARE
TX75-2616977-028OtherTRICARE
TX75-2616977OtherRAIL ROAD
TX75-2616977-001OtherTRICARE
TX75-2616977-002OtherTRICARE
TX75-2616977-118OtherTRICARE
TX302017401Medicaid
TX302017402Medicaid
TXP01081606OtherRAIL ROAD
TX8DG764OtherBCBS