Provider Demographics
NPI:1407415938
Name:KABA, BINTOU G (NP)
Entity Type:Individual
Prefix:
First Name:BINTOU
Middle Name:G
Last Name:KABA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9200 WILDWOOD ST
Mailing Address - Street 2:
Mailing Address - City:LORTON
Mailing Address - State:VA
Mailing Address - Zip Code:22079-1818
Mailing Address - Country:US
Mailing Address - Phone:703-863-4656
Mailing Address - Fax:
Practice Address - Street 1:820 FOLLIN LN SE
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22180-4907
Practice Address - Country:US
Practice Address - Phone:703-206-2122
Practice Address - Fax:703-206-1371
Is Sole Proprietor?:No
Enumeration Date:2019-06-09
Last Update Date:2019-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024177658363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care