Provider Demographics
NPI:1982264628
Name:LUBIN, KAITLYN (AGPCNP)
Entity Type:Individual
Prefix:
First Name:KAITLYN
Middle Name:
Last Name:LUBIN
Suffix:
Gender:F
Credentials:AGPCNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:69 JAMES ST
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:PA
Mailing Address - Zip Code:18704-4722
Mailing Address - Country:US
Mailing Address - Phone:570-877-8862
Mailing Address - Fax:
Practice Address - Street 1:100 UPPER DEMUNDS RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:PA
Practice Address - Zip Code:18612-8811
Practice Address - Country:US
Practice Address - Phone:888-694-9996
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-15
Last Update Date:2019-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAG06190049363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner