Provider Demographics
NPI:1265982334
Name:LIEBEL, KAYLYN PLUM
Entity type:Individual
Prefix:MRS
First Name:KAYLYN
Middle Name:PLUM
Last Name:LIEBEL
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:KAYLYN
Other - Middle Name:ELIZABETH
Other - Last Name:PLUM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:328 GRAND ST APT 6A
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10002-4580
Mailing Address - Country:US
Mailing Address - Phone:727-542-5176
Mailing Address - Fax:
Practice Address - Street 1:160 7TH AVE S
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10014-2727
Practice Address - Country:US
Practice Address - Phone:727-542-5176
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-12
Last Update Date:2022-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant