Provider Demographics
NPI:1053350496
Name:KUBLY, PAMELA L (CPNP)
Entity type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:L
Last Name:KUBLY
Suffix:
Gender:F
Credentials:CPNP
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Mailing Address - Street 1:4112 OUTLOOK BLVD
Mailing Address - Street 2:SUITE 255
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81008-1667
Mailing Address - Country:US
Mailing Address - Phone:719-253-7640
Mailing Address - Fax:719-253-7644
Practice Address - Street 1:4112 OUTLOOK BLVD
Practice Address - Street 2:SUITE 255
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81008-1667
Practice Address - Country:US
Practice Address - Phone:719-253-7640
Practice Address - Fax:719-253-7644
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO59676363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO07596760Medicaid