Provider Demographics
NPI:1376317149
Name:JOBBINS, KELLY LYNN
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:LYNN
Last Name:JOBBINS
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 1:18086 K 192 HWY
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:KS
Mailing Address - Zip Code:66097-3093
Mailing Address - Country:US
Mailing Address - Phone:913-683-4391
Mailing Address - Fax:
Practice Address - Street 1:10979 214TH RD
Practice Address - Street 2:
Practice Address - City:NORTONVILLE
Practice Address - State:KS
Practice Address - Zip Code:66060-5068
Practice Address - Country:US
Practice Address - Phone:913-360-2542
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-13
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider