Provider Demographics
NPI:1700421393
Name:YBARBO, KIM ANNETTE
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:ANNETTE
Last Name:YBARBO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1266 E CAMBRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-3611
Mailing Address - Country:US
Mailing Address - Phone:417-343-6971
Mailing Address - Fax:
Practice Address - Street 1:1266 E CAMBRIDGE ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-3611
Practice Address - Country:US
Practice Address - Phone:417-343-6971
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-07
Last Update Date:2019-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO1999139433225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant