Provider Demographics
NPI:1619452760
Name:HUBBARD, DREW MCKENZIE (MSN, FNP-C)
Entity Type:Individual
Prefix:MS
First Name:DREW
Middle Name:MCKENZIE
Last Name:HUBBARD
Suffix:
Gender:F
Credentials:MSN, FNP-C
Other - Prefix:MS
Other - First Name:DREW
Other - Middle Name:MCKENZIE
Other - Last Name:REYNOLDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:112 MONTROSE CT APT 63
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36305-6620
Mailing Address - Country:US
Mailing Address - Phone:334-791-3790
Mailing Address - Fax:
Practice Address - Street 1:1108 ROSS CLARK CIR
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36301-3022
Practice Address - Country:US
Practice Address - Phone:334-944-4278
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-25
Last Update Date:2018-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-107806163W00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse