Provider Demographics
NPI:1235449158
Name:BIBBEE, VANESSA LEIGH (FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:VANESSA
Middle Name:LEIGH
Last Name:BIBBEE
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 TRACY WAY 2
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25311-1262
Mailing Address - Country:US
Mailing Address - Phone:304-388-4965
Mailing Address - Fax:304-343-4850
Practice Address - Street 1:3100 MACCORKLE AVE SE STE 202
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25304-1228
Practice Address - Country:US
Practice Address - Phone:304-388-4965
Practice Address - Fax:304-388-4968
Is Sole Proprietor?:No
Enumeration Date:2010-10-13
Last Update Date:2015-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV66678363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
BINP39531Medicare PIN