Individual
JESSE J KIBERT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
4 COMMERCE LANE, CANTON, NY 13617-3739
(315) 386-8191
(315) 386-1410
Mailing address
4 COMMERCE LANE, P.O. BOX 407, CANTON, NY 13617-3739
(315) 386-8191
(315) 386-1410
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
014002
NY
363AM0700X
Medical Physician Assistant
—
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01995615
—
NY
05
—
100427890B
—
KS
01
—
110809
BLUE CROSS/BLUE SHIELD GROUP
KS
Enumeration date
08/07/2008
Last updated
07/06/2011
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