Provider Demographics
NPI:1801354428
Name:KIEBLER, MORGAN ELIZABETH
Entity type:Individual
Prefix:
First Name:MORGAN
Middle Name:ELIZABETH
Last Name:KIEBLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 TECHNOLOGY DR STE 204
Mailing Address - Street 2:
Mailing Address - City:BUTLER
Mailing Address - State:PA
Mailing Address - Zip Code:16001-1801
Mailing Address - Country:US
Mailing Address - Phone:724-482-4257
Mailing Address - Fax:724-482-4785
Practice Address - Street 1:104 TECHNOLOGY DR STE 204
Practice Address - Street 2:
Practice Address - City:BUTLER
Practice Address - State:PA
Practice Address - Zip Code:16001-1801
Practice Address - Country:US
Practice Address - Phone:724-482-4257
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-04
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
PAMA060695363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program