Provider Demographics
NPI:1346592102
Name:KIBBEY, SCARLETT FERN
Entity Type:Individual
Prefix:
First Name:SCARLETT
Middle Name:FERN
Last Name:KIBBEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4950 APACHE AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32210-8334
Mailing Address - Country:US
Mailing Address - Phone:904-716-8594
Mailing Address - Fax:
Practice Address - Street 1:4950 APACHE AVE
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32210-8334
Practice Address - Country:US
Practice Address - Phone:904-716-8594
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-03
Last Update Date:2012-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker