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General NPI Number Information
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NPI Number | 1902101934
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Entity Type | Individual
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Provider Name | JILL TIBKE N.P.
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Gender | Female
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Dates
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Enumeration Date | 01/23/2011
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Last Update Date | 06/25/2015
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Provider Practice Location Address
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Address Line | 19550 E 39TH ST S STE. 210
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City | INDEPENDENCE
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State | MO
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Zip | 64057-2303
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Country | US
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Telephone | 816-478-9071
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Fax |
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Provider Business Mailing Address
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Address Line | 3901 RAINBOW BLVD SUITE G600
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City | KANSAS CITY
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State | KS
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Zip | 66160-8500
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Country | US
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Telephone | 913-588-9449
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Fax | 913-945-7453
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 2001023168
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 53-75056-031
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License Number State | KS
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