Provider Demographics
NPI:1568843126
Name:KABA, DONNA MARIE (NP)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:MARIE
Last Name:KABA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:DONNA
Other - Middle Name:MARIE
Other - Last Name:CLEGG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 2153 DEPT 40338
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35287-9386
Mailing Address - Country:US
Mailing Address - Phone:423-310-1642
Mailing Address - Fax:
Practice Address - Street 1:1 EVERGREEN DR
Practice Address - Street 2:
Practice Address - City:EAST PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02914-1506
Practice Address - Country:US
Practice Address - Phone:401-438-3250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-09
Last Update Date:2020-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN252453363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health