=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427593920
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARGARET KLEIBOEKER FNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/20/2016
-----------------------------------------------------
Last Update Date | 03/20/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 117 E HICKORY ST
-----------------------------------------------------
City | NEOSHO
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 64850-1806
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 417-451-4545
-----------------------------------------------------
Fax | 417-389-2341
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 117 E HICKORY ST
-----------------------------------------------------
City | NEOSHO
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 64850-1806
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 417-451-4545
-----------------------------------------------------
Fax | 417-389-2341
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 2016044706
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------