Healthcare Provider Details

I. General information

NPI: 1346224698
Provider Name (Legal Business Name): COLEEN M KIEFER APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/30/2005
Last Update Date: 10/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 HUEBNER ROAD IRWIN ARMY COMMUNITY HOSPITAL
FT RILEY KS
66442-7037
US

IV. Provider business mailing address

650 HUEBNER ROAD IRWIN ARMY COMMUNITY HOSPITAL
FT RILEY KS
66442-7037
US

V. Phone/Fax

Practice location:
  • Phone: 785-240-7678
  • Fax:
Mailing address:
  • Phone: 785-240-7678
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number45629
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number608838
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: