Provider Demographics
NPI:1194796813
Name:KIBLER-MCCORMICK, JAIME LYN (DO)
Entity type:Individual
Prefix:DR
First Name:JAIME
Middle Name:LYN
Last Name:KIBLER-MCCORMICK
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:JAIME
Other - Middle Name:KIBLER
Other - Last Name:CORY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:PO BOX 746638
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-6638
Mailing Address - Country:US
Mailing Address - Phone:904-202-1032
Mailing Address - Fax:904-376-4107
Practice Address - Street 1:30 ARDISIA LANE
Practice Address - Street 2:
Practice Address - City:ST. JOHNS
Practice Address - State:FL
Practice Address - Zip Code:32259
Practice Address - Country:US
Practice Address - Phone:904-287-2794
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2022-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS9402207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL009172600Medicaid
FLP01321205OtherRAILROAD MEDICARE
FLAD277WMedicare PIN
AD277XMedicare PIN