Provider Demographics
NPI:1013172022
Name:LYBARGER, KRISTOPHER SHAWN (DO)
Entity Type:Individual
Prefix:DR
First Name:KRISTOPHER
Middle Name:SHAWN
Last Name:LYBARGER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2340 E MEYER BLVD BLDG 2
Mailing Address - Street 2:STE 546
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64132-1105
Mailing Address - Country:US
Mailing Address - Phone:816-926-0777
Mailing Address - Fax:816-926-0707
Practice Address - Street 1:2340 E MEYER BLVD BLDG 2
Practice Address - Street 2:STE 546
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64132-1105
Practice Address - Country:US
Practice Address - Phone:816-926-0777
Practice Address - Fax:816-926-0707
Is Sole Proprietor?:No
Enumeration Date:2008-07-20
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101017678207V00000X
MO2015025644207VX0201X
PAOS015980207V00000X
KS0538312207VX0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic Oncology
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102699106Medicaid
PA2697299OtherHIGHMARK BLUE SHIELD
PA30120311OtherAMERIHEALTH MERCY - WMG
PA1609940OtherGATEWAY
PA418499OtherUPMC
PA2697299OtherHIGHMARK BLUE SHIELD