Individual
JACOB TIBBS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
122 12TH STREET EXT, PRINCETON, WV 24740-2352
(304) 487-7000
Mailing address
PO BOX 7023, PRINCETON, WV 24740-0197
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
0001282301
VA
367500000X
Certified Registered Nurse Anesthetist
Primary
113030
WV
Other
Enumeration date
04/05/2022
Last updated
09/08/2022
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