Provider Demographics
NPI:1336542430
Name:BIBB, KIMBERLY H (APRN)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:H
Last Name:BIBB
Suffix:
Gender:F
Credentials:APRN
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 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:904-202-2092
Mailing Address - Fax:907-376-4075
Practice Address - Street 1:1888 S 14TH ST
Practice Address - Street 2:CREDENTIALING DEPARTMENT
Practice Address - City:FERNANDINA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32034-3054
Practice Address - Country:US
Practice Address - Phone:904-261-0922
Practice Address - Fax:904-277-8872
Is Sole Proprietor?:No
Enumeration Date:2014-10-02
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 9165603363LF0000X
FLAPRN9165603363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP01390059OtherRR MEDICARE
FLHZ029ZMedicare PIN