Provider Demographics
NPI:1700409018
Name:JABBES, KIMBERLY BOYD (DNP, AGPCNP-BC)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:BOYD
Last Name:JABBES
Suffix:
Gender:F
Credentials:DNP, AGPCNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2468 W MALRAUX DR
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83815-0438
Mailing Address - Country:US
Mailing Address - Phone:208-310-2959
Mailing Address - Fax:
Practice Address - Street 1:2468 W MALRAUX DR
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83815-0438
Practice Address - Country:US
Practice Address - Phone:208-310-2959
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-20
Last Update Date:2020-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID62841363LG0600X
WAAP61006337363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology