MEDICARE: LIBBY ANN JOHN AGNP

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	363LA2200X	Adult Health Nurse Practitioner	81691	KS
2	363LA2200X	Adult Health Nurse Practitioner	70324	NM
3	363LA2200X	Adult Health Nurse Practitioner	AP128178	TX
4	363LA2200X	Adult Health Nurse Practitioner	209.027660	IL

General Provider Information

NPI Number	:	1598149932
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LIBBY ANN JOHN AGNP

Provider Business Mailing Address
First Line	:	6603 RUSK LANDING CT
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77049-3505
Country	:	US
Telephone Number	:	832-605-8352
Fax Number	:

Provider Business Practice Location Address
First Line	:	6603 RUSK LANDING CT
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77049-3505
Country	:	US
Telephone Number	:	832-605-8352
Fax Number	:

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

Provider Enumeration Date	:	07/15/2015
Last Update Date	:	01/09/2024

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