Provider Demographics
NPI:1811916679
Name:HIBBARD, JAMES MITCHELL (MPAS, PA-C)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:MITCHELL
Last Name:HIBBARD
Suffix:
Gender:M
Credentials:MPAS, PA-C
Other - Prefix:
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Mailing Address - Street 1:4700 LAS VEGAS BLVD N
Mailing Address - Street 2:
Mailing Address - City:NELLIS AFB
Mailing Address - State:NV
Mailing Address - Zip Code:89191-6600
Mailing Address - Country:US
Mailing Address - Phone:702-653-2091
Mailing Address - Fax:702-653-3622
Practice Address - Street 1:104 PHYSICIANS PARK DR
Practice Address - Street 2:
Practice Address - City:ROCKINGHAM
Practice Address - State:NC
Practice Address - Zip Code:28379-5204
Practice Address - Country:US
Practice Address - Phone:910-895-1989
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2018-02-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC00102549363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
P43222Medicare UPIN
2753511CMedicare ID - Type Unspecified