Individual
TOMMIE LEE MCKIBBAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
720 WEST CENTRAL, EL DORADO, KS 67042
(316) 321-3300
Mailing address
PO BOX 388, NEWTON, KS 67114-0388
(316) 281-3700
(316) 282-4322
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
54002
KS
Other
Enumeration date
02/22/2006
Last updated
05/12/2011
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