Provider Demographics
NPI:1295962942
Name:KIRBY, BRADLEY LAMAR (RN)
Entity type:Individual
Prefix:
First Name:BRADLEY
Middle Name:LAMAR
Last Name:KIRBY
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 GOVERNORS DRIVE SW
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801
Mailing Address - Country:US
Mailing Address - Phone:256-518-9998
Mailing Address - Fax:256-518-9941
Practice Address - Street 1:29495 COPPERHEAD LANE
Practice Address - Street 2:
Practice Address - City:ELKMONT
Practice Address - State:AL
Practice Address - Zip Code:35620
Practice Address - Country:US
Practice Address - Phone:256-732-4452
Practice Address - Fax:256-732-4430
Is Sole Proprietor?:No
Enumeration Date:2009-06-19
Last Update Date:2009-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-090571163W00000X, 163WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WP0200XNursing Service ProvidersRegistered NursePediatrics