Individual
SHELBY R KIEBEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
7411 HOPE DR STE C, FORT WAYNE, IN 46815-5687
(260) 234-5400
(260) 234-5395
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
71001617A
IN
363LF0000X
Family Nurse Practitioner
71001617A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1102405962
ANTHEM PTAN
IN
05
—
200468450
—
IN
Enumeration date
01/23/2007
Last updated
01/09/2025
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