Individual
JACOB RYAN GIBSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
X
Contact information
Practice address
17720 NE HALSEY ST STE A, PORTLAND, OR 97230-6771
(503) 654-7654
(503) 654-7333
Mailing address
3587 HEATHROW WAY, MEDFORD, OR 97504-4004
(541) 858-8170
(541) 858-8167
Taxonomy
Speciality
Code
Description
License number
State
163WP0809X
Adult Psychiatric/Mental Health Registered Nurse
Primary
10051976
OR
Other
Enumeration date
01/12/2026
Last updated
01/13/2026
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