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1104713437 NPI number — JOHANNAH MARIE MCKIBBEN RN, BSN, FNP, MSN

NPI Number: 1104713437
Health Care Provider/Practitioner: JOHANNAH MARIE MCKIBBEN RN, BSN, FNP, MSN

Information about “1104713437” NPI (JOHANNAH MARIE MCKIBBEN RN, BSN, FNP, MSN) exists in 1104713437 in HTML format HTML  |  1104713437 in plain Text format TXT  |  1104713437 in PDF (Portable Document Format) PDF  |  1104713437 in an XML format XML  formats.

NPI Number : 1104713437 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1104713437",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "MCKIBBEN",
    "FirstName": "JOHANNAH",
    "MiddleName": "MARIE",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "RN, BSN, FNP, MSN",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "PO BOX 3755",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "OMAHA",
    "MailingAddressStateName": "NE",
    "MailingAddressPostalCode": "68103-0755",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "402-354-2100",
    "MailingAddressFaxNumber": "402-354-2155",
    "FirstLinePracticeLocationAddress": "320 EBAUGH ST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "GLENWOOD",
    "PracticeLocationAddressStateName": "IA",
    "PracticeLocationAddressPostalCode": "51534-1811",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "712-624-9185",
    "PracticeLocationAddressFaxNumber": "712-396-4180",
    "EnumerationDate": "06/19/2025",
    "LastUpdateDate": "10/17/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "363L00000X",
        "TaxonomyName": "Nurse Practitioner",
        "LicenseNumber": "A186196",
        "LicenseNumberStateCode": "NE",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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