Provider Demographics
NPI:1952062150
Name:RIEBMAN, KACIE LYNNE (PA-C)
Entity Type:Individual
Prefix:
First Name:KACIE
Middle Name:LYNNE
Last Name:RIEBMAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3876 CEPHAS CHILD RD UNIT 2
Mailing Address - Street 2:
Mailing Address - City:DOYLESTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18902-9029
Mailing Address - Country:US
Mailing Address - Phone:215-317-7901
Mailing Address - Fax:
Practice Address - Street 1:1745 S EASTON RD
Practice Address - Street 2:
Practice Address - City:DOYLESTOWN
Practice Address - State:PA
Practice Address - Zip Code:18901-2812
Practice Address - Country:US
Practice Address - Phone:267-880-4200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-10
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant