Basic Information
Provider Information
NPI: 1497425102
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: KUBE
FirstName: REBEKAH
MiddleName: LYNN
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 12248
Address2:  
City: NEW BERN
State: NC
PostalCode: 285612248
CountryCode: US
TelephoneNumber: 2525146685
FaxNumber: 2525142745
Practice Location
Address1: 1020 MEDICAL PARK AVE
Address2:  
City: NEW BERN
State: NC
PostalCode: 285625248
CountryCode: US
TelephoneNumber: 2525146685
FaxNumber: 2525142745
Other Information
ProviderEnumerationDate: 09/14/2021
LastUpdateDate: 05/09/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 05/09/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LF0000X5015019NCY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

No ID Information.


Home