Provider Demographics
NPI:1043961097
Name:WILSON KIBBE, JUDY LYNN (RCP)
Entity type:Individual
Prefix:
First Name:JUDY
Middle Name:LYNN
Last Name:WILSON KIBBE
Suffix:
Gender:F
Credentials:RCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 COUNTY ROAD 621
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:TX
Mailing Address - Zip Code:77535-4950
Mailing Address - Country:US
Mailing Address - Phone:832-675-2278
Mailing Address - Fax:617-507-8756
Practice Address - Street 1:15 RYE ST STE 305
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801-6846
Practice Address - Country:US
Practice Address - Phone:888-320-1776
Practice Address - Fax:617-507-8756
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-11
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes227800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, CertifiedGroup - Single Specialty