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NPI Code Detail

MEDICARE: MR. GIBRIL KELLEH KARGBO NP

MEDICARE: MR. GIBRIL KELLEH KARGBO NP
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
1363LP0808XPsychiatric/Mental Health Nurse PractitionerAP60951772WA
2363LF0000XFamily Nurse PractitionerC-APN.0001023-C-NPCO

General Provider Information

NPI Number : 1609386440
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. GIBRIL KELLEH KARGBO NP
Provider Business Mailing Address
First Line : PO BOX 73488
Second Line :
City : PUYALLUP
State : WA
Zip : 98373-0488
Country : US
Telephone Number : 855-722-9700
Fax Number :
Provider Business Practice Location Address
First Line : 2219 RIMLAND DR STE 301
Second Line :
City : BELLINGHAM
State : WA
Zip : 98226-8759
Country : US
Telephone Number : 855-722-9700
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/06/2017
Last Update Date : 11/28/2022

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