Provider Demographics
NPI:1386662690
Name:NIBBELINK, LARRY W (MD)
Entity type:Individual
Prefix:DR
First Name:LARRY
Middle Name:W
Last Name:NIBBELINK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:16180 W 135TH ST
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66062-1517
Mailing Address - Country:US
Mailing Address - Phone:913-441-4544
Mailing Address - Fax:913-422-8462
Practice Address - Street 1:16180 W 135TH ST
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66062-1517
Practice Address - Country:US
Practice Address - Phone:913-441-4544
Practice Address - Fax:913-422-8462
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0418150207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100163710AMedicaid
CO3121OtherPTAN RR
KS100163710AMedicaid