MEDICARE: JESSICA MIRANDA HIBBS BCBA, LBA

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	103K00000X	Behavior Analyst	0133004678	VA

General Provider Information

NPI Number	:	1669265559
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA MIRANDA HIBBS BCBA, LBA

Provider Business Mailing Address
First Line	:	4218 DUSTY RD
Second Line	:
City	:	BARBOURSVILLE
State	:	VA
Zip	:	22923-2014
Country	:	US
Telephone Number	:	757-968-7733
Fax Number	:

Provider Business Practice Location Address
First Line	:	4870 SADLER ROAD
Second Line	:	SUITE 300
City	:	GLEN ALLEN
State	:	VA
Zip	:	23060-6294
Country	:	US
Telephone Number	:	855-832-6727
Fax Number	:	772-675-9100

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

Provider Enumeration Date	:	05/23/2025
Last Update Date	:	06/18/2026

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