Provider Demographics
NPI:1386897635
Name:KINABREW, NAKECIA DUNGAN (FNP-BC)
Entity type:Individual
Prefix:
First Name:NAKECIA
Middle Name:DUNGAN
Last Name:KINABREW
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 ELLIS DEAR RD
Mailing Address - Street 2:
Mailing Address - City:HARRISVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39082-4036
Mailing Address - Country:US
Mailing Address - Phone:601-845-0680
Mailing Address - Fax:
Practice Address - Street 1:1842 SIMPSON HIGHWAY 149
Practice Address - Street 2:
Practice Address - City:MENDENHALL
Practice Address - State:MS
Practice Address - Zip Code:39114-3438
Practice Address - Country:US
Practice Address - Phone:601-847-2221
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-30
Last Update Date:2008-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR856047363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily