Provider Demographics
NPI:1134407422
Name:MCKIBBEN, KAYLA NICOLE (PHD)
Entity type:Individual
Prefix:DR
First Name:KAYLA
Middle Name:NICOLE
Last Name:MCKIBBEN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:KAYLA
Other - Middle Name:NICOLE
Other - Last Name:HAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:1 FEDERAL DRIVE
Mailing Address - Street 2:BISHOP HENRY WHIPPLE BUILDING
Mailing Address - City:ST. PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55111
Mailing Address - Country:US
Mailing Address - Phone:612-467-7901
Mailing Address - Fax:
Practice Address - Street 1:601 HIGHWAY 6 W
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52246-2209
Practice Address - Country:US
Practice Address - Phone:319-338-0581
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-03
Last Update Date:2024-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA001219103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling