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NPI Code Detail

MEDICARE: SUSAN WANGARI KIBE APRN

MEDICARE: SUSAN WANGARI KIBE APRN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LP0808XPsychiatric/Mental Health Nurse Practitioner215675OK
2363L00000XNurse Practitioner215675OK
3363LP0808XPsychiatric/Mental Health Nurse Practitioner1140059TX

General Provider Information

NPI Number : 1699305870
Entity Type Code : Individual
Provider Name (Legal Business Name) : SUSAN WANGARI KIBE APRN
Provider Business Mailing Address
First Line : 527 W 3RD ST
Second Line :
City : KONAWA
State : OK
Zip : 74849-1415
Country : US
Telephone Number : 580-925-3286
Fax Number : 580-925-2362
Provider Business Practice Location Address
First Line : 625 N MONTE VISTA ST
Second Line :
City : ADA
State : OK
Zip : 74820-4613
Country : US
Telephone Number : 580-436-5111
Fax Number : 580-436-1159
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/16/2020
Last Update Date : 04/14/2026

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