Provider Demographics
NPI:1912470212
Name:KIBLER, SANDRA KAY (CFNP)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:KAY
Last Name:KIBLER
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:700 W IRONWOOD DRIVE
Mailing Address - Street 2:SUITE 155
Mailing Address - City:COEUR D'ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-4462
Mailing Address - Country:US
Mailing Address - Phone:208-667-0585
Mailing Address - Fax:208-765-6075
Practice Address - Street 1:700 W. IRONWOOD DRIVE
Practice Address - Street 2:SUITE 155
Practice Address - City:COEUR D'ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-4462
Practice Address - Country:US
Practice Address - Phone:208-667-0585
Practice Address - Fax:208-765-6075
Is Sole Proprietor?:No
Enumeration Date:2019-01-09
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDNP60444363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily