MEDICARE: KATHRYN ANN TRIBBEY NP CNM

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	363LX0001X	Obstetrics & Gynecology Nurse Practitioner	354173	CA
2	363LX0001X	Obstetrics & Gynecology Nurse Practitioner	4634	CA
3	176B00000X	Midwife	350	CA

General Provider Information

NPI Number	:	1790742070
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHRYN ANN TRIBBEY NP CNM

Provider Business Mailing Address
First Line	:	300 N SAN ANTONIO RD
Second Line	:
City	:	SANTA BARBARA
State	:	CA
Zip	:	93110-1316
Country	:	US
Telephone Number	:	805-681-5461
Fax Number	:

Provider Business Practice Location Address
First Line	:	116 S PALISADE DR
Second Line	:	SUITE 104
City	:	SANTA MARIA
State	:	CA
Zip	:	93454-8904
Country	:	US
Telephone Number	:	805-739-8710
Fax Number	:	805-739-8732

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

Provider Enumeration Date	:	04/28/2006
Last Update Date	:	03/14/2013

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