Provider Demographics
NPI:1508168873
Name:HUBBARD, FREDA YVONNE (APRN)
Entity Type:Individual
Prefix:MRS
First Name:FREDA
Middle Name:YVONNE
Last Name:HUBBARD
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:FREDA
Other - Middle Name:
Other - Last Name:MEADOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:746 CAMPBELL LN
Mailing Address - Street 2:SUITE 101
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42104-1000
Mailing Address - Country:US
Mailing Address - Phone:270-843-9510
Mailing Address - Fax:270-843-9511
Practice Address - Street 1:746 CAMPBELL LN
Practice Address - Street 2:SUITE 101
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42104-1000
Practice Address - Country:US
Practice Address - Phone:270-843-9510
Practice Address - Fax:270-843-9511
Is Sole Proprietor?:No
Enumeration Date:2010-11-18
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY6720P363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily