Provider Demographics
NPI:1841221371
Name:NIBLOCK, JENNY L (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:JENNY
Middle Name:L
Last Name:NIBLOCK
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 E COLLEGE DR
Mailing Address - Street 2:
Mailing Address - City:COLBY
Mailing Address - State:KS
Mailing Address - Zip Code:67701-3716
Mailing Address - Country:US
Mailing Address - Phone:785-462-6184
Mailing Address - Fax:785-460-1490
Practice Address - Street 1:310 E COLLEGE DR
Practice Address - Street 2:
Practice Address - City:COLBY
Practice Address - State:KS
Practice Address - Zip Code:67701-3716
Practice Address - Country:US
Practice Address - Phone:785-462-6184
Practice Address - Fax:785-460-1490
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2015-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS44744363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS44744OtherKANSAS LICENSE
KS100342210BMedicaid
KS102404Medicare PIN
S58535Medicare UPIN