Active NPI
Deborah L Kirby, CPC
- Peer Specialist
- Lacey, WA
National Provider Identifier
1912402850
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Peer Specialist
- License
- CG60815969
- Practice address
- 612 Woodland Square Loop SE Ste 401
Lacey, WA 98503-1070 - Phone
- (360) 972-0461
- Fax
- (360) 489-1435
- NPI assigned
- Mar 23, 2018
- 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 |
|---|---|---|---|---|
| Peer Specialist | 175T00000X | CG60815969 | WA | Primary |
Addresses
Primary practice location
612 Woodland Square Loop SE Ste 401
Lacey, WA 98503-1070
Mailing address
612 Woodland Square Loop SE Ste 401
Lacey, WA 98503-1070
Phone (360) 972-0461
Other practice location 1
908 5th Ave SE
Olympia, WA 98501-1507
Phone (360) 754-2423
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1912402850 | Medicaid | WA |
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 |
|---|---|---|---|
| CG60815969 | WA | MD | Peer Specialist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Thurston Mason Behavioral Health Organization | Past | Accepting new patients | |
| Olympic Health and Recovery Services | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Community/Behavioral Health Agency
- Lacey, WA
- NPI 1760007504
-
- Community/Behavioral Health Agency
- Lacey, WA
- NPI 1265932198
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1521763200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1551398400000",
"number": "1912402850",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "612 WOODLAND SQUARE LOOP SE STE 401",
"city": "LACEY",
"state": "WA",
"postal_code": "985031070",
"telephone_number": "360-972-0461",
"fax_number": "360-357-2819"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "612 WOODLAND SQUARE LOOP SE STE 401",
"city": "LACEY",
"state": "WA",
"postal_code": "985031070",
"telephone_number": "360-972-0461",
"fax_number": "360-489-1435"
}
],
"practiceLocations": [
{
"address_1": "908 5th Ave SE",
"address_purpose": "LOCATION",
"city": "Olympia",
"state": "WA",
"postal_code": "985011507",
"country_code": "US",
"telephone_number": "360-754-2423",
"fax_number": "360-357-2819",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "KIRBY",
"first_name": "DEBORAH",
"middle_name": "L",
"credential": "CPC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2018-03-23",
"last_updated": "2019-03-01",
"status": "A"
},
"taxonomies": [
{
"code": "175T00000X",
"taxonomy_group": "",
"desc": "Peer Specialist",
"state": "WA",
"license": "CG60815969",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1912402850",
"state": "WA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Lacey, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 1, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.