Provider Demographics
NPI:1134316755
Name:BABBITT CLINIC, P.L.L.C.
Entity Type:Organization
Organization Name:BABBITT CLINIC, P.L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:A
Authorized Official - Last Name:BABBITT
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:928-783-0600
Mailing Address - Street 1:PO BOX 4878
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85366-4878
Mailing Address - Country:US
Mailing Address - Phone:928-783-0600
Mailing Address - Fax:928-783-3091
Practice Address - Street 1:411 W 8TH ST
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-2957
Practice Address - Country:US
Practice Address - Phone:928-783-0600
Practice Address - Fax:928-783-3091
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-27
Last Update Date:2007-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP1473363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ734336Medicaid
AZ734336Medicaid
AZ70001Medicare PIN