Provider Demographics
NPI:1558707810
Name:KIBE, LUCY WACHERA (PA-C)
Entity Type:Individual
Prefix:
First Name:LUCY
Middle Name:WACHERA
Last Name:KIBE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1845 N 23RD ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19121-2055
Mailing Address - Country:US
Mailing Address - Phone:215-235-3110
Mailing Address - Fax:215-235-4441
Practice Address - Street 1:1845 N 23RD ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19121-2055
Practice Address - Country:US
Practice Address - Phone:215-235-3110
Practice Address - Fax:215-235-4441
Is Sole Proprietor?:No
Enumeration Date:2013-05-14
Last Update Date:2013-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA056071363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical