Provider Demographics
NPI:1730487281
Name:HIBNER, KELLY (RN)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:HIBNER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:939 NW 71 ROAD
Mailing Address - Street 2:
Mailing Address - City:CHILHOWEE
Mailing Address - State:MO
Mailing Address - Zip Code:64733
Mailing Address - Country:US
Mailing Address - Phone:660-383-6059
Mailing Address - Fax:800-864-1060
Practice Address - Street 1:939 NW 71 ROAD
Practice Address - Street 2:
Practice Address - City:CHILHOWEE
Practice Address - State:MO
Practice Address - Zip Code:64733
Practice Address - Country:US
Practice Address - Phone:660-383-6059
Practice Address - Fax:800-864-1060
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-08
Last Update Date:2024-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2024005728163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse