Basic Information
| Provider Information | |||||||||
| NPI: | 1104364496 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KIRBY | ||||||||
| FirstName: | JUSTIN | ||||||||
| MiddleName: | LANCE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2205 MCCALLIE AVE STE 310 | ||||||||
| Address2: | |||||||||
| City: | CHATTANOOGA | ||||||||
| State: | TN | ||||||||
| PostalCode: | 374043334 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4236982435 | ||||||||
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| Practice Location | |||||||||
| Address1: | 975 E 3RD ST | ||||||||
| Address2: | HOSPITALIST | ||||||||
| City: | CHATTANOOGA | ||||||||
| State: | TN | ||||||||
| PostalCode: | 374032147 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4237785179 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/07/2017 | ||||||||
| LastUpdateDate: | 12/22/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 12/22/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 22286 | TN | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.