MEDICARE: DAVID GERALD HIBBS APRN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	RN00156444	WA
2	363LF0000X	Family Nurse Practitioner	AP30007167	WA
3	363LF0000X	Family Nurse Practitioner	200950024NP	OR

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	8857797	OTHER	OR	MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1427092683
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID GERALD HIBBS APRN

Provider Business Mailing Address
First Line	:	3910 NE 99TH AVE
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97220-3620
Country	:	US
Telephone Number	:	503-917-5928
Fax Number	:	503-917-5929

Provider Business Practice Location Address
First Line	:	1808 SE 182ND AVE
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97233-5120
Country	:	US
Telephone Number	:	503-917-5928
Fax Number	:	503-917-5929

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/16/2006
Last Update Date	:	11/09/2020

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Directions to “ DAVID GERALD HIBBS APRN” Practice Location

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