Individual provider Active NPI

Kaitlyn Lubin, AGPCNP

  • Nurse Practitioner
  • Dallas, PA
National Provider Identifier
1982264628
Registry record updated Jun 15, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
AG06190049 Issued in PA
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

Updated by the provider on Jun 15, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
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

LicenseStateTypeSpecialty
AG06190049PAMDNurse 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.

Verify at the official NPI Registry.