Healthcare Provider Details

I. General information

NPI: 1851469191
Provider Name (Legal Business Name): AMY LYNN KUBIAK FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMY LYNN BAUN

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1034 SCOTCH BONNET WAY
SUMMERVILLE SC
29485-9281
US

IV. Provider business mailing address

1034 SCOTCH BONNET WAY
SUMMERVILLE SC
29485-9281
US

V. Phone/Fax

Practice location:
  • Phone: 716-984-3595
  • Fax:
Mailing address:
  • Phone: 716-984-3595
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number334925
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number30285
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: