Healthcare Provider Details

I. General information

NPI: 1023071388
Provider Name (Legal Business Name): JENNIFER LYNN KIBBEY PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER LYNN BROWN PA

II. Dates (important events)

Enumeration Date: 04/08/2006
Last Update Date: 10/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5040 FOREST DR
NEW ALBANY OH
43054-8167
US

IV. Provider business mailing address

70 S CLEVELAND AVE
WESTERVILLE OH
43081-1397
US

V. Phone/Fax

Practice location:
  • Phone: 614-890-6555
  • Fax: 614-891-1484
Mailing address:
  • Phone: 614-890-6555
  • Fax: 614-823-8881

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number50.001845
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number50.001845
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: