Provider Demographics
NPI:1205561420
Name:KIRBY, AMANDA KAY (CPNP-PC)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:KAY
Last Name:KIRBY
Suffix:
Gender:F
Credentials:CPNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3001 DAGGETT AVE
Mailing Address - Street 2:
Mailing Address - City:KLAMATH FALLS
Mailing Address - State:OR
Mailing Address - Zip Code:97601-1118
Mailing Address - Country:US
Mailing Address - Phone:530-351-4120
Mailing Address - Fax:
Practice Address - Street 1:3001 DAGGETT AVE
Practice Address - Street 2:
Practice Address - City:KLAMATH FALLS
Practice Address - State:OR
Practice Address - Zip Code:97601-1118
Practice Address - Country:US
Practice Address - Phone:541-851-4800
Practice Address - Fax:541-851-4801
Is Sole Proprietor?:No
Enumeration Date:2022-07-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR202210762NP-PP363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics