Provider Demographics
NPI:1679266233
Name:KIBURIS, JESSICA SUZANNE (MSN, APRN, FNP-C)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:SUZANNE
Last Name:KIBURIS
Suffix:
Gender:F
Credentials:MSN, APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1504
Mailing Address - Street 2:
Mailing Address - City:ROUND MOUNTAIN
Mailing Address - State:NV
Mailing Address - Zip Code:89045-1504
Mailing Address - Country:US
Mailing Address - Phone:702-497-7831
Mailing Address - Fax:
Practice Address - Street 1:1 SMOKY VALLEY MINE ROAD
Practice Address - Street 2:
Practice Address - City:ROUND MOUNTAIN
Practice Address - State:NV
Practice Address - Zip Code:89045
Practice Address - Country:US
Practice Address - Phone:775-377-3267
Practice Address - Fax:775-377-3368
Is Sole Proprietor?:No
Enumeration Date:2023-05-31
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV867258363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily