Basic Information
| Provider Information | |||||||||
| NPI: | 1013172022 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LYBARGER | ||||||||
| FirstName: | KRISTOPHER | ||||||||
| MiddleName: | SHAWN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2340 E MEYER BLVD BLDG 2 | ||||||||
| Address2: | STE 546 | ||||||||
| City: | KANSAS CITY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 641321105 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8169260777 | ||||||||
| FaxNumber: | 8169260707 | ||||||||
| Practice Location | |||||||||
| Address1: | 2340 E MEYER BLVD BLDG 2 | ||||||||
| Address2: | STE 546 | ||||||||
| City: | KANSAS CITY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 641321105 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8169260777 | ||||||||
| FaxNumber: | 8169260707 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/20/2008 | ||||||||
| LastUpdateDate: | 01/27/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 5101017678 | MI | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 207VX0201X | 2015025644 | MO | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Gynecologic Oncology | 207V00000X | OS015980 | PA | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 207VX0201X | 0538312 | KS | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Gynecologic Oncology |
ID Information
| ID | Type | State | Issuer | Description | 102699106 | 05 | PA | MEDICAID | 2697299 | 01 | PA | HIGHMARK BLUE SHIELD | OTHER | 30120311 | 01 | PA | AMERIHEALTH MERCY - WMG | OTHER | 1609940 | 01 | PA | GATEWAY | OTHER | 418499 | 01 | PA | UPMC | OTHER |