Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Tyler Patrick McKibben, MD

Individual provider Physician Assistant · NPI 1083425243

Tyler Patrick McKibben, MD is a Physician Assistant in Carbondale, Illinois. Works from 2 locations. Licensed in Illinois and Missouri.

Licensed in
IL, MO
In the registry since
2025
Specialties on file
3
What do these letters mean?
MD — Doctor of Medicine
A physician who completed allopathic medical school.

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Practice location Address checks out

300 W Oak St Ste 200
Carbondale, IL 62901-1400
Phone: (618) 536-6621
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 611 W Main St, Fredericktown, MO 63645-1146 — (573) 783-3341

Specialties & licences

Family Medicine Physician (primary) Taxonomy 207Q00000X · Licence 125086259 (IL)
Physician Assistant Taxonomy 363A00000X (MO)
Physician Assistant Taxonomy 363A00000X · Licence 2025005124 (MO)

Record details

NPI number1083425243
Entity typeIndividual (Type 1)
GenderMale
Credentials MD
Sole proprietorNo
NPI enumeratedJanuary 16, 2025
Last updated in NPPESJuly 8, 2025
Certification dateJuly 8, 2025
Mailing address300 W Oak St Ste 200, Carbondale, IL 62901-1400

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