Provider Demographics
NPI:1518533306
Name:KABURIA, JOHN B (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:B
Last Name:KABURIA
Suffix:
Gender:M
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 MIDWAY DRIVE
Mailing Address - Street 2:STE 3
Mailing Address - City:HARRINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19952-2448
Mailing Address - Country:US
Mailing Address - Phone:800-818-8680
Mailing Address - Fax:800-818-8680
Practice Address - Street 1:642 SOUTH QUEEN STREET
Practice Address - Street 2:STE 102
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19904-3506
Practice Address - Country:US
Practice Address - Phone:800-818-8680
Practice Address - Fax:800-818-8680
Is Sole Proprietor?:No
Enumeration Date:2021-06-02
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEL8-0010223363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health