Brent Logan Kirby, MA

Key facts

NPI

1154097111

Entity type

Individual (NPI type 1)

Primary specialty

Pastoral Counselor 101YP1600X

Practice address

17345 N 150 E
Summitville, IN 46070-9121

Phone

(907) 690-1701

NPI assigned

Aug 19, 2021

Sex

Male

Sole proprietor

Yes

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

No

Credentials

Master of Arts

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Aug 19, 2021.

{
    "created_epoch": "1629331200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1629331200000",
    "number": "1154097111",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 305",
            "city": "SUMMITVILLE",
            "state": "IN",
            "postal_code": "460700305"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17345 N 150 E",
            "city": "SUMMITVILLE",
            "state": "IN",
            "postal_code": "460709121",
            "telephone_number": "907-690-1701"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIRBY",
        "first_name": "BRENT",
        "middle_name": "LOGAN",
        "name_prefix": "Mr.",
        "credential": "MA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-08-19",
        "last_updated": "2021-08-19",
        "certification_date": "2021-08-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP1600X",
            "taxonomy_group": "",
            "desc": "Counselor, Pastoral",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Summitville, IN

• Community Hospitals of Indiana Inc
• Kimberly S. Hodge, PHD, RN, ACNS-BC
• Miggin Montanay Hutson
• Abigail L Manwell
• Amanda Middleton, MOT, OTR/L
• Putnam County Hospital
• Abe Rosenthall, DMD
• Megan Nicole Stroup, LSW

All providers in Summitville, IN · Pastoral Counselor in Indiana