Provider Demographics
NPI:1700354503
Name:KIRBY, TASONDA MICHELLE
Entity Type:Individual
Prefix:
First Name:TASONDA
Middle Name:MICHELLE
Last Name:KIRBY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25145 S 4130 RD
Mailing Address - Street 2:
Mailing Address - City:CLAREMORE
Mailing Address - State:OK
Mailing Address - Zip Code:74019-0249
Mailing Address - Country:US
Mailing Address - Phone:918-504-6726
Mailing Address - Fax:
Practice Address - Street 1:25145 S 4130 RD
Practice Address - Street 2:
Practice Address - City:CLAREMORE
Practice Address - State:OK
Practice Address - Zip Code:74019-0249
Practice Address - Country:US
Practice Address - Phone:918-504-6726
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-09
Last Update Date:2018-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist