Provider Demographics
NPI:1346789682
Name:BIVENS, JESSE K (ARNP)
Entity Type:Individual
Prefix:
First Name:JESSE
Middle Name:K
Last Name:BIVENS
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5741 N 26TH ST UNIT 115
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98407-2415
Mailing Address - Country:US
Mailing Address - Phone:253-756-3737
Mailing Address - Fax:253-756-3799
Practice Address - Street 1:5741 N 26TH ST UNIT 115
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98407-2415
Practice Address - Country:US
Practice Address - Phone:253-756-3737
Practice Address - Fax:253-756-3799
Is Sole Proprietor?:No
Enumeration Date:2017-02-20
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60732867363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2076252Medicaid