MEDICARE: KATIE BIBY

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	99700	OK

General Provider Information

NPI Number	:	1720451594
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATIE BIBY

Provider Business Mailing Address
First Line	:	4196 HIGHWAY 62 412 STE A
Second Line	:
City	:	HARDY
State	:	AR
Zip	:	72542-8002
Country	:	US
Telephone Number	:	870-856-2100
Fax Number	:

Provider Business Practice Location Address
First Line	:	1201 E HARTFORD AVE
Second Line	:
City	:	PONCA CITY
State	:	OK
Zip	:	74601-2018
Country	:	US
Telephone Number	:	580-762-1911
Fax Number	:

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

Provider Enumeration Date	:	11/03/2015
Last Update Date	:	10/07/2025

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Directions to “ KATIE BIBY ” Practice Location

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