Provider Demographics
NPI:1861070989
Name:KIRBY, STACY (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:
Last Name:KIRBY
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:STAVY
Other - Middle Name:
Other - Last Name:LOVINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:832 HIGHWAY 15 N
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:KY
Mailing Address - Zip Code:41339-8284
Mailing Address - Country:US
Mailing Address - Phone:606-666-5142
Mailing Address - Fax:606-666-4172
Practice Address - Street 1:832 HIGHWAY 15 N
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:KY
Practice Address - Zip Code:41339-8284
Practice Address - Country:US
Practice Address - Phone:606-666-5142
Practice Address - Fax:606-666-4172
Is Sole Proprietor?:No
Enumeration Date:2021-03-30
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3015980363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100773010Medicaid