Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363L00000X | Nurse Practitioner | 1-042956 | AL |
Y | 363LP2300X | Nurse Practitioner - Primary Care | 1-042956 | AL |
NPI | 1053432468 |
---|---|
Provider Name | Kimberly O'chab |
First Address | Mobile, AL 36608-1775 |
Second Address | Mobile, AL 36608-1771 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/04/2007 |
Last Update Date | 11/05/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
P09331 | (02) | AL |