Provider Demographics
NPI:1972847374
Name:KIBLER, LAUREL SUSAN (FNP)
Entity Type:Individual
Prefix:MS
First Name:LAUREL
Middle Name:SUSAN
Last Name:KIBLER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 WEST REX ALLEN DRIVE
Mailing Address - Street 2:
Mailing Address - City:WILLCOX
Mailing Address - State:AZ
Mailing Address - Zip Code:85643
Mailing Address - Country:US
Mailing Address - Phone:520-384-3541
Mailing Address - Fax:520-384-4553
Practice Address - Street 1:900 W SCOTT ST
Practice Address - Street 2:
Practice Address - City:WILLCOX
Practice Address - State:AZ
Practice Address - Zip Code:85643-1017
Practice Address - Country:US
Practice Address - Phone:520-384-4421
Practice Address - Fax:520-384-4645
Is Sole Proprietor?:No
Enumeration Date:2012-11-26
Last Update Date:2012-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP4754363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily