Provider Demographics
NPI:1255091104
Name:KIBBY, ANJANETTE (FNP-C)
Entity type:Individual
Prefix:
First Name:ANJANETTE
Middle Name:
Last Name:KIBBY
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4045 W CHANDLER BLVD BLDG F
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85226-3732
Mailing Address - Country:US
Mailing Address - Phone:480-494-2062
Mailing Address - Fax:480-353-2066
Practice Address - Street 1:4045 W CHANDLER BLVD BLDG F
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85226-3732
Practice Address - Country:US
Practice Address - Phone:480-494-2062
Practice Address - Fax:480-353-2066
Is Sole Proprietor?:No
Enumeration Date:2021-12-20
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZTEMP266412363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZTEMP266412OtherNP LICENSE