Provider Demographics
NPI:1538405733
Name:RIEBE, KIMBERLY JEAN (FNP/MSN)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:JEAN
Last Name:RIEBE
Suffix:
Gender:F
Credentials:FNP/MSN
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:JEAN
Other - Last Name:CLINE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 843966
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64184-3966
Mailing Address - Country:US
Mailing Address - Phone:573-884-3300
Mailing Address - Fax:573-884-0943
Practice Address - Street 1:404 N KEENE ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-6626
Practice Address - Country:US
Practice Address - Phone:573-499-6084
Practice Address - Fax:573-499-6088
Is Sole Proprietor?:No
Enumeration Date:2012-12-17
Last Update Date:2019-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016017859363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1538405733Medicaid
VAPAROtherUSA MANAGED CARE
VA1538405733Medicaid
VA10118704NOtherOPTIMA HEALTH
VA-001OtherTRICARE/CHAMPUS
VA1538405733OtherVIRGINIA PREMIER HEALTH PLAN
VAPAROtherCORVEL
VAPAROtherMULTIPLAN
VAPAROtherMULTIPLAN