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General NPI Number Information
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NPI Number | 1922836329
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Entity Type | Individual
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Provider Name | KRISTA RENEE TIBBS CPNP-PC
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Gender | Female
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Dates
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Enumeration Date | 07/25/2024
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Last Update Date | 07/25/2024
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Provider Practice Location Address
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Address Line | 1 MEDICAL CENTER DR
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City | MORGANTOWN
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State | WV
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Zip | 26506-1200
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Country | US
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Telephone | 304-598-4000
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Fax |
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Provider Business Mailing Address
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Address Line | 460 BLACKBERRY RIDGE DR
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City | MORGANTOWN
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State | WV
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Zip | 26508-4869
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Country | US
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Telephone | 304-288-1209
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080P0206X
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Taxonomy Name | Pediatric Gastroenterology Physician
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License Number | 120448
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License Number State | WV
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