Basic Information
| Provider Information | |||||||||
| NPI: | 1386897635 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KINABREW | ||||||||
| FirstName: | NAKECIA | ||||||||
| MiddleName: | DUNGAN | ||||||||
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| Credential: | FNP-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 131 ELLIS DEAR RD | ||||||||
| Address2: | |||||||||
| City: | HARRISVILLE | ||||||||
| State: | MS | ||||||||
| PostalCode: | 390824036 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6018450680 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1842 SIMPSON HIGHWAY 149 | ||||||||
| Address2: | |||||||||
| City: | MENDENHALL | ||||||||
| State: | MS | ||||||||
| PostalCode: | 391143438 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6018472221 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/30/2008 | ||||||||
| LastUpdateDate: | 10/30/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | R856047 | MS | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.