1386897635 NPI number — NAKECIA DUNGAN KINABREW FNP-BC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386897635 NPI number — NAKECIA DUNGAN KINABREW FNP-BC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KINABREW
Provider First Name:
NAKECIA
Provider Middle Name:
DUNGAN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
FNP-BC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1386897635
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/30/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
131 ELLIS DEAR RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HARRISVILLE
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
39082-4036
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
601-845-0680
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1842 SIMPSON HIGHWAY 149
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MENDENHALL
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39114-3438
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
601-847-2221
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/30/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  R856047 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com