Provider Demographics
NPI:1184669970
Name:NIBERT, CAROL M (MD)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:M
Last Name:NIBERT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8035
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67208-0035
Mailing Address - Country:US
Mailing Address - Phone:316-689-9135
Mailing Address - Fax:316-689-9102
Practice Address - Street 1:9211 E 21ST ST N
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67206-2968
Practice Address - Country:US
Practice Address - Phone:316-609-4501
Practice Address - Fax:316-636-4076
Is Sole Proprietor?:No
Enumeration Date:2006-06-17
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS27106207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100018OtherHPK
KS12149385OtherMULTIPLAN
KS16976OtherCOVENTRY
KS051619OtherBCBS
KS10061OtherPHS
G48778Medicare UPIN
KS12149385OtherMULTIPLAN