Provider Demographics
NPI:1871592014
Name:KIBBEL, PEGGY (ARNP,CNM)
Entity type:Individual
Prefix:
First Name:PEGGY
Middle Name:
Last Name:KIBBEL
Suffix:
Gender:F
Credentials:ARNP,CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 116TH AVE NE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-3043
Mailing Address - Country:US
Mailing Address - Phone:425-454-3366
Mailing Address - Fax:425-943-3201
Practice Address - Street 1:1800 116TH AVE NE
Practice Address - Street 2:SUITE 201
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-3043
Practice Address - Country:US
Practice Address - Phone:425-454-3366
Practice Address - Fax:425-943-3201
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2009-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30005594363LW0102X, 367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9628223Medicaid
WAS06843Medicare UPIN
WA9628223Medicaid
WAG8880894Medicare PIN
WAAB25505Medicare PIN