Active NPI
Kaitlyn Lubin, AGPCNP
- Nurse Practitioner
- Dallas, PA
National Provider Identifier
1982264628
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse Practitioner
- License
- AG06190049
- Practice address
- 100 Upper Demunds Rd
Dallas, PA 18612-8811 - Phone
- (888) 694-9996
- NPI assigned
- Jun 15, 2019
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | AG06190049 | PA | Primary |
Addresses
Primary practice location
100 Upper Demunds Rd
Dallas, PA 18612-8811
Mailing address
69 James St
Kingston, PA 18704-4722
Phone (570) 877-8862
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| AG06190049 | PA | MD | Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1560556800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1560556800000",
"number": "1982264628",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "69 JAMES ST",
"city": "KINGSTON",
"state": "PA",
"postal_code": "187044722",
"telephone_number": "570-877-8862"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "100 UPPER DEMUNDS RD",
"city": "DALLAS",
"state": "PA",
"postal_code": "186128811",
"telephone_number": "888-694-9996"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LUBIN",
"first_name": "KAITLYN",
"credential": "AGPCNP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-06-15",
"last_updated": "2019-06-15",
"status": "A"
},
"taxonomies": [
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "PA",
"license": "AG06190049",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Dallas, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.