Provider Demographics
NPI:1306994629
Name:GIBBENS, KATHY (RNFA)
Entity type:Individual
Prefix:
First Name:KATHY
Middle Name:
Last Name:GIBBENS
Suffix:
Gender:F
Credentials:RNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2264
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97075-2264
Mailing Address - Country:US
Mailing Address - Phone:971-506-6870
Mailing Address - Fax:503-642-9434
Practice Address - Street 1:9432 SW 164TH AVE
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97007-9415
Practice Address - Country:US
Practice Address - Phone:971-506-6870
Practice Address - Fax:503-642-9434
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2008-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR094000296RN163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR341686OtherPROVIDENCE HEALTH PLANS