Provider Demographics
NPI:1558453472
Name:KEMP, BOBBY CHARLES (CRNP)
Entity Type:Individual
Prefix:
First Name:BOBBY
Middle Name:CHARLES
Last Name:KEMP
Suffix:
Gender:M
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 1255
Mailing Address - Street 2:644 ADAMS STREET
Mailing Address - City:PAXTON
Mailing Address - State:FL
Mailing Address - Zip Code:32538-1255
Mailing Address - Country:US
Mailing Address - Phone:850-834-3722
Mailing Address - Fax:
Practice Address - Street 1:24245 5TH AVE
Practice Address - Street 2:
Practice Address - City:FLORALA
Practice Address - State:AL
Practice Address - Zip Code:36442-3523
Practice Address - Country:US
Practice Address - Phone:334-858-2050
Practice Address - Fax:334-858-2120
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-054821363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALP27583Medicare UPIN