Provider Demographics
NPI:1598337933
Name:LEAVITT, KABRINA KAY (FNP-BC)
Entity Type:Individual
Prefix:
First Name:KABRINA
Middle Name:KAY
Last Name:LEAVITT
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1028 N SHILLING AVE
Mailing Address - Street 2:
Mailing Address - City:BLACKFOOT
Mailing Address - State:ID
Mailing Address - Zip Code:83221-1845
Mailing Address - Country:US
Mailing Address - Phone:208-604-0208
Mailing Address - Fax:
Practice Address - Street 1:1028 N SHILLING AVE
Practice Address - Street 2:
Practice Address - City:BLACKFOOT
Practice Address - State:ID
Practice Address - Zip Code:83221-1845
Practice Address - Country:US
Practice Address - Phone:208-604-0208
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-14
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID68989363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily