Provider Demographics
NPI:1174988950
Name:JUBB, KIMBERLY DAWN (FNP)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:DAWN
Last Name:JUBB
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 470
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE COURT HOUSE
Mailing Address - State:VA
Mailing Address - Zip Code:23923-0470
Mailing Address - Country:US
Mailing Address - Phone:434-542-5560
Mailing Address - Fax:
Practice Address - Street 1:165 LEGRANDE AVE.
Practice Address - Street 2:
Practice Address - City:CHARLOTTE COURT HOUSE
Practice Address - State:VA
Practice Address - Zip Code:23923
Practice Address - Country:US
Practice Address - Phone:434-542-5560
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-22
Last Update Date:2015-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024173126363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily