Provider Demographics
NPI:1639863913
Name:JENNIFERKUBINNP
Entity Type:Organization
Organization Name:JENNIFERKUBINNP
Other - Org Name:PRAIRIE PSYCHIATRIC CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:KUBIN
Authorized Official - Suffix:
Authorized Official - Credentials:APRN, PMHNP-BC
Authorized Official - Phone:785-347-8921
Mailing Address - Street 1:394 E 1807TH RD
Mailing Address - Street 2:
Mailing Address - City:BALDWIN CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66006-7369
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:715 HIGH ST STE B
Practice Address - Street 2:
Practice Address - City:BALDWIN CITY
Practice Address - State:KS
Practice Address - Zip Code:66006-3015
Practice Address - Country:US
Practice Address - Phone:913-221-1643
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-08
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty