Healthcare Provider Details

I. General information

NPI: 1346789682
Provider Name (Legal Business Name): JESSE K BIVENS ARNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2017
Last Update Date: 03/27/2024
Certification Date: 03/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5741 N 26TH ST UNIT 115
TACOMA WA
98407-2415
US

IV. Provider business mailing address

5741 N 26TH ST UNIT 115
TACOMA WA
98407-2415
US

V. Phone/Fax

Practice location:
  • Phone: 253-756-3737
  • Fax: 253-756-3799
Mailing address:
  • Phone: 253-756-3737
  • Fax: 253-756-3799

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP60732867
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: