Provider Demographics
NPI:1992116958
Name:MEWBOURN, KAREY (APRN)
Entity type:Individual
Prefix:
First Name:KAREY
Middle Name:
Last Name:MEWBOURN
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 1:9940 S OCEAN DR APT 802
Mailing Address - Street 2:
Mailing Address - City:JENSEN BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:34957-2412
Mailing Address - Country:US
Mailing Address - Phone:863-610-0334
Mailing Address - Fax:802-423-3380
Practice Address - Street 1:2251 E GRANT RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85719-3414
Practice Address - Country:US
Practice Address - Phone:520-222-7482
Practice Address - Fax:802-423-3380
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-13
Last Update Date:2024-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP2918082363LF0000X
FLAPRN2918082363LF0000X
AZ269495363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL012050700Medicaid