Provider Demographics
NPI:1710736897
Name:TIBBY, KACY-ANN JULIANA
Entity type:Individual
Prefix:
First Name:KACY-ANN
Middle Name:JULIANA
Last Name:TIBBY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 8TH ST APT 1A
Mailing Address - Street 2:
Mailing Address - City:MC KEES ROCKS
Mailing Address - State:PA
Mailing Address - Zip Code:15136-2194
Mailing Address - Country:US
Mailing Address - Phone:412-636-7235
Mailing Address - Fax:
Practice Address - Street 1:801 8TH ST APT 1A
Practice Address - Street 2:
Practice Address - City:MC KEES ROCKS
Practice Address - State:PA
Practice Address - Zip Code:15136-2194
Practice Address - Country:US
Practice Address - Phone:412-636-7235
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-13
Last Update Date:2024-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty