Healthcare Provider Details

I. General information

NPI: 1851205611
Provider Name (Legal Business Name): CHEYENNE RAE KIBBY FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2026
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

406 N STATE ST
GOBLES MI
49055-9717
US

IV. Provider business mailing address

1704 SIGNAL POINT CIR
ALLEGAN MI
49010-8786
US

V. Phone/Fax

Practice location:
  • Phone: 269-628-2196
  • Fax:
Mailing address:
  • Phone: 269-355-0046
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4704372809
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: