Provider Demographics
NPI:1801064738
Name:KLINKEBIEL, KYLEEN (PA)
Entity type:Individual
Prefix:
First Name:KYLEEN
Middle Name:
Last Name:KLINKEBIEL
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 488
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:NE
Mailing Address - Zip Code:69022-0488
Mailing Address - Country:US
Mailing Address - Phone:308-697-3317
Mailing Address - Fax:308-697-4176
Practice Address - Street 1:309 NELSON ST
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:NE
Practice Address - Zip Code:69022-3592
Practice Address - Country:US
Practice Address - Phone:308-697-3317
Practice Address - Fax:308-697-4176
Is Sole Proprietor?:No
Enumeration Date:2008-02-13
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1374363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant