Provider Demographics
NPI:1356719876
Name:KIBBE-HERRING, GEORGETTE (NP-C)
Entity type:Individual
Prefix:
First Name:GEORGETTE
Middle Name:
Last Name:KIBBE-HERRING
Suffix:
Gender:F
Credentials:NP-C
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 652
Mailing Address - Street 2:
Mailing Address - City:MILLICAN
Mailing Address - State:TX
Mailing Address - Zip Code:77866-0652
Mailing Address - Country:US
Mailing Address - Phone:979-599-4970
Mailing Address - Fax:877-589-1469
Practice Address - Street 1:610 HARVEST DR
Practice Address - Street 2:
Practice Address - City:COLLEGE STATION
Practice Address - State:TX
Practice Address - Zip Code:77845-7317
Practice Address - Country:US
Practice Address - Phone:979-599-4970
Practice Address - Fax:877-589-1469
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-15
Last Update Date:2024-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP129014363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty