1013172022 NPI number — DR. KRISTOPHER SHAWN LYBARGER D.O.

Table of content: KENESIA R. LAWRENCE (NPI 1174230148)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013172022 NPI number — DR. KRISTOPHER SHAWN LYBARGER D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LYBARGER
Provider First Name:
KRISTOPHER
Provider Middle Name:
SHAWN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.O.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1013172022
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/27/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2340 E MEYER BLVD BLDG 2
Provider Second Line Business Mailing Address:
STE 546
Provider Business Mailing Address City Name:
KANSAS CITY
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64132-1105
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
816-926-0777
Provider Business Mailing Address Fax Number:
816-926-0707

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2340 E MEYER BLVD BLDG 2
Provider Second Line Business Practice Location Address:
STE 546
Provider Business Practice Location Address City Name:
KANSAS CITY
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64132-1105
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-926-0777
Provider Business Practice Location Address Fax Number:
816-926-0707
Provider Enumeration Date:
07/20/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X , with the licence number:  5101017678 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207VX0201X , with the licence number: 2015025644 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207V00000X , with the licence number: OS015980 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207VX0201X , with the licence number: 0538312 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 102699106 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2697299 . This is a "HIGHMARK BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 30120311 . This is a "AMERIHEALTH MERCY - WMG" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1609940 . This is a "GATEWAY" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 418499 . This is a "UPMC" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".