Healthcare Provider Details

I. General information

NPI: 1235752833
Provider Name (Legal Business Name): RUEGBA BEKIBELE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2020
Last Update Date: 09/18/2024
Certification Date: 09/18/2024
Deactivation Date: 01/17/2022
Reactivation Date: 03/01/2022

III. Provider practice location address

2214 CANTERBURY DR STE 204
HAYS KS
67601-2375
US

IV. Provider business mailing address

2220 CANTERBURY DR
HAYS KS
67601-2370
US

V. Phone/Fax

Practice location:
  • Phone: 785-623-2360
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0449992
License Number StateKS

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: