Active NPI
Stacy Kirby, KCSA
- Surgical Assistant
- Bowling Green, KY
National Provider Identifier
1417304304
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgical Assistant
- License
- SA296
- Practice address
- 1945 Scottsville Rd
B2 PMB 397
Bowling Green, KY 42104-3376 - Phone
- (270) 781-4828
- Fax
- (270) 781-4828
- NPI assigned
- May 20, 2016
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgical Assistant | 246ZC0007X | SA296 | KY | Primary |
Addresses
Primary practice location
1945 Scottsville Rd
B2 PMB 397
Bowling Green, KY 42104-3376
Mailing address
1945 Scottsville Rd
B2 PMB 397
Bowling Green, KY 42104-3376
Phone (270) 781-4828
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| SA296 | KY | MD | Surgical Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1463702400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1463702400000",
"number": "1417304304",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1945 SCOTTSVILLE RD",
"address_2": "B2 PMB 397",
"city": "BOWLING GREEN",
"state": "KY",
"postal_code": "421043376",
"telephone_number": "270-781-4828",
"fax_number": "270-781-4828"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1945 SCOTTSVILLE RD",
"address_2": "B2 PMB 397",
"city": "BOWLING GREEN",
"state": "KY",
"postal_code": "421043376",
"telephone_number": "270-781-4828",
"fax_number": "270-781-4828"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIRBY",
"first_name": "STACY",
"credential": "KCSA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2016-05-20",
"last_updated": "2016-05-20",
"status": "A"
},
"taxonomies": [
{
"code": "246ZC0007X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Other, Surgical Assistant",
"state": "KY",
"license": "SA296",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bowling Green, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.