Provider Demographics
NPI:1265762066
Name:KIRBY, KENDI ELISE (PA-C)
Entity type:Individual
Prefix:MRS
First Name:KENDI
Middle Name:ELISE
Last Name:KIRBY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:KENDI
Other - Middle Name:ELISE
Other - Last Name:PELOT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:616 E OAK ST
Mailing Address - Street 2:
Mailing Address - City:ATMORE
Mailing Address - State:AL
Mailing Address - Zip Code:36502-3617
Mailing Address - Country:US
Mailing Address - Phone:251-229-0565
Mailing Address - Fax:
Practice Address - Street 1:1121 BELLEVILLE AVE
Practice Address - Street 2:
Practice Address - City:BREWTON
Practice Address - State:AL
Practice Address - Zip Code:36426-1500
Practice Address - Country:US
Practice Address - Phone:251-809-3240
Practice Address - Fax:251-809-6051
Is Sole Proprietor?:No
Enumeration Date:2009-12-30
Last Update Date:2014-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPA676363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant