MEDICARE: EVERETT C MCKIBBEN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208D00000X	General Practice Physician	12519	MS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1093873713
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EVERETT C MCKIBBEN MD

Provider Business Mailing Address
First Line	:	THE LAIRD CLINIC
Second Line	:	103 DOCTORS PARK
City	:	STARKVILLE
State	:	MS
Zip	:	39759
Country	:	US
Telephone Number	:	662-323-2515
Fax Number	:	662-323-2557

Provider Business Practice Location Address
First Line	:	THE LAIRD CLINIC
Second Line	:	103 DOCTORS PARK
City	:	STARKVILLE
State	:	MS
Zip	:	39759
Country	:	US
Telephone Number	:	662-323-2515
Fax Number	:	662-323-2557

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/05/2006
Last Update Date	:	01/13/2026

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