MEDICARE: SHELBY R KIEBEL NP

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	363LF0000X	Family Nurse Practitioner	71001617A	IN
2	363L00000X	Nurse Practitioner	71001617A	IN

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
2	1102405962	OTHER	IN	ANTHEM PTAN

General Provider Information

NPI Number	:	1669526695
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHELBY R KIEBEL NP

Provider Business Mailing Address
First Line	:	250 N SHADELAND AVE
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46219-4959
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7411 HOPE DR STE C
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46815-5687
Country	:	US
Telephone Number	:	260-234-5400
Fax Number	:	260-234-5395

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

Provider Enumeration Date	:	01/23/2007
Last Update Date	:	01/09/2025

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