Healthcare Provider Details

I. General information

NPI: 1134546294
Provider Name (Legal Business Name): MRS. TAMMY IRBY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2014
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1190 N STATE ST SUITE 301
JACKSON MS
39202-2413
US

IV. Provider business mailing address

PO BOX 94
MENDENHALL MS
39114-0094
US

V. Phone/Fax

Practice location:
  • Phone: 769-233-8239
  • Fax: 601-944-9780
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: