Healthcare Provider Details

I. General information

NPI: 1730487281
Provider Name (Legal Business Name): KELLY HIBNER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/08/2011
Last Update Date: 06/17/2024
Certification Date: 06/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

939 NW 71 ROAD
CHILHOWEE MO
64733
US

IV. Provider business mailing address

939 NW 71 ROAD
CHILHOWEE MO
64733
US

V. Phone/Fax

Practice location:
  • Phone: 660-383-6059
  • Fax: 800-864-1060
Mailing address:
  • Phone: 660-383-6059
  • Fax: 800-864-1060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number2024005728
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: