Provider Demographics
NPI:1841294576
Name:KIRBY, THOMAS E (PA-C)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:E
Last Name:KIRBY
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:417 RIVER DR
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:KY
Mailing Address - Zip Code:40336-1272
Mailing Address - Country:US
Mailing Address - Phone:606-723-0399
Mailing Address - Fax:606-723-0379
Practice Address - Street 1:417 RIVER DR
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:KY
Practice Address - Zip Code:40336-1272
Practice Address - Country:US
Practice Address - Phone:606-723-0399
Practice Address - Fax:606-723-0379
Is Sole Proprietor?:No
Enumeration Date:2005-06-10
Last Update Date:2009-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPA853363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY0678407Medicare ID - Type Unspecified
KYQ39494Medicare UPIN