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General NPI Number Information
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NPI Number | 1639863913
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Entity Type | Organization
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Legal Business Name | JENNIFERKUBINNP
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Dates
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Enumeration Date | 06/08/2023
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Last Update Date | 07/17/2023
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Provider Practice Location Address
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Address Line | 715 HIGH ST STE B
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City | BALDWIN CITY
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State | KS
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Zip | 66006-3015
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Country | US
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Telephone | 913-221-1643
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Fax |
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Provider Business Mailing Address
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Address Line | 394 E 1807TH RD
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City | BALDWIN CITY
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State | KS
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Zip | 66006-7369
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JENNIFER KUBIN
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Credential | APRN, PMHNP-BC
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Telephone | 785-347-8921
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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