MEDICARE: JAMIE R. KIRBY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	311ZA0620X	Adult Care Home Facility	FCL012033	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1235341728
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JAMIE R. KIRBY

Provider Business Mailing Address
First Line	:	3208 TEX'S FISH CAMP ROAD
Second Line	:
City	:	CONNELLYS SPRINGS
State	:	NC
Zip	:	28612-7633
Country	:	US
Telephone Number	:	828-397-6090
Fax Number	:

Provider Business Practice Location Address
First Line	:	3208 TEX'S FISH CAMP ROAD
Second Line	:
City	:	CONNELLYS SPRINGS
State	:	NC
Zip	:	28612-7633
Country	:	US
Telephone Number	:	828-397-6090
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR/OWNER
Name	:	JAMIE ROCKETT KIRBY
Credential	:
Telephone Number	:	828-397-6090

Provider Enumeration Date	:	05/04/2007
Last Update Date	:	09/01/2009

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