Provider Demographics
NPI:1609386440
Name:KARGBO, GIBRIL KELLEH (NP)
Entity Type:Individual
Prefix:MR
First Name:GIBRIL
Middle Name:KELLEH
Last Name:KARGBO
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 73488
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98373-0488
Mailing Address - Country:US
Mailing Address - Phone:855-722-9700
Mailing Address - Fax:
Practice Address - Street 1:2219 RIMLAND DR STE 301
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98226-8759
Practice Address - Country:US
Practice Address - Phone:855-722-9700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-06
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60951772363LP0808X
COC-APN.0001023-C-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health