DEIDRE BIBB (NPI# 1891269056) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1891269056 |
Entity Type | Individual |
Full Name | DEIDRE BIBB |
Practice Address |
1814 Roseland Blvd Ste 100 Tyler TX 75701-4262 |
Mailing Address |
102 S Stewart St White Oak TX 75693-1514 |
Practice Telephone | 9035253300 |
Mailing Telephone | 9035700602 |
Enumeration Date | 2019-01-21 |
Last Update Date | 2019-01-21 |
Gender Code | F |
Is Sole Proprietor | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 2083S0010X |
Preventive Medicine Specialization: Sports Medicine |
120402065-AT2240 | TX | Allopathic & Osteopathic Physicians |
Street Address |
1814 ROSELAND BLVD STE 100 |
City | TYLER |
State | TX |
Zip Code | 75701-4262 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1033691324 | Karley Ann Ritchie | Physical Therapy Assistant | 1814 Roseland Blvd Ste 100, Tyler, TX 75701-4262 | 2018-09-03 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1962057059 | Gonzalo Fernandez | Physical Therapy Assistant | 753 S Beckham Ave, Tyler, TX 75701 | 2019-08-06 |
1215422654 | Adrianna Bussell | Nurse Practitioner | 1000 South Beckham, Tyler, TX 75701 | 2018-06-28 |
1285128017 | Idowu Akintokunbo Akinyele | Dentist | Aspen Dental, 4164 S Broadway Ave, Tyler, TX 75701 | 2018-06-15 |
1992208912 | Heather Renee Vancleave | Occupational Therapy Assistant | 1228 Louann Lane, Tyler, TX 75701 | 2018-03-15 |
1497260533 | Smile Workshop Mckinney, Pllc | Dentist | 301 N. Custer Rd, Mckinney, TX 75701 | 2017-12-12 |
1396266441 | Eye Surgery Center of East Texas, Pllc | Clinic/Center | 2448 E 5th St, Tyler, TX 75701 | 2017-06-29 |
1962936369 | Collins Complete Family Care | Nurse Practitioner | 1910 E Se Loop 323 # 176, Tyler, TX 75701 | 2017-04-12 |
1386187052 | Fellowship Health Team LLC | Home Health | 1124 S Fleishel Ave, Tyler, TX 75701 | 2016-11-29 |
1205382454 | Brenton Robinson | Nurse Practitioner | 1100 East Lake St, 160, Tyler, TX 75701 | 2016-08-28 |
1851846208 | Care First Pharmacy, LLC | Pharmacy | 1910 Roseland Blvd A, Tyler, TX 75701 | 2016-08-15 |
Find all providers in zip 75701 |
Taxonomy Code | 2083S0010X |
Grouping | Allopathic & Osteopathic Physicians |
Classification | Preventive Medicine |
Specialization | Sports Medicine |
A preventive medicine physician who specializes in the diagnosis and treatment of sports related conditions and injuries. |
Notes: Source: National Uniform Claim Committee, 2009 [1/1/2010: definition added, source added] Additional Resources: A Certification of Added Qualifications (CAQ) is issued by the American Osteopathic Board of Preventive Medicine. |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1811506538 | Regenerate Atx Pllc | Preventive Medicine | 11610 Fm 2244 Rd Ste 230, Austin, TX 78738-5457 | 2020-07-28 |
1063057602 | Heather Penka | Preventive Medicine | 820 Holiday Ln, North Richland Hills, TX 76180 | 2019-11-07 |
1588030241 | Texas A&m University | Preventive Medicine | 12 John David Crow Blvd, College Station, TX 77843 | 2015-08-18 |
1952378556 | David B. Tsai, M.d., P.a. | Preventive Medicine | 210 Barton Springs Rd, Suite 200, Austin, TX 78704-1254 | 2006-03-02 |
1013526201 | Kimberly Moore | Preventive Medicine | 1333 W Washington St, Stephenville, TX 76401-4168 | 2020-07-24 |
1104382936 | Ashley Christine Wagner | Preventive Medicine | 3724 Executive Center Dr Ste G10, Austin, TX 78731-1665 | 2019-02-18 |
1891169686 | Tracy Coleman IIi | Preventive Medicine | 6000 Eldorado Pkwy, Apt# 222, Frisco, TX 75033-3573 | 2015-11-17 |
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Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.