Individual provider Active NPI

Jeffrey S. Tebbs, DNP, PHD

  • Psychiatric/Mental Health Nurse Practitioner
  • Olympia, WA
National Provider Identifier
1114181989
Registry record updated Oct 2, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
AP60045999 Issued in WA
Practice address
525 Columbia St NW Ste 202
Olympia, WA 98501-1098
Phone
(360) 878-9312
Fax
(360) 878-9887
NPI assigned
Jul 10, 2008
Last updated
Oct 2, 2024By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 2, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 11996960-4405 UT
Adult Psychiatric/Mental Health Registered Nurse 163WP0809X RN00164186 WA
Psychiatric/Mental Health Nurse Practitioner 363LP0808X AP60045999 WA Primary

Addresses

Primary practice location

525 Columbia St NW Ste 202
Olympia, WA 98501-1098

Mailing address

525 Columbia St NW Ste 202
Olympia, WA 98501-1098
Phone (360) 878-9312

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
RN00164186WAMDAdult Psychiatric/Mental Health Registered Nurse
11996960-4405UTMDPsychiatric/Mental Health Nurse Practitioner
AP60045999WAMDPsychiatric/Mental Health Nurse Practitioner

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1215648000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1727827200000",
    "number": "1114181989",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "525 COLUMBIA ST NW STE 202",
            "city": "OLYMPIA",
            "state": "WA",
            "postal_code": "985011098",
            "telephone_number": "360-878-9312"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "525 COLUMBIA ST NW STE 202",
            "city": "OLYMPIA",
            "state": "WA",
            "postal_code": "985011098",
            "telephone_number": "360-878-9312",
            "fax_number": "360-878-9887"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TEBBS",
        "first_name": "JEFFREY",
        "middle_name": "S.",
        "name_prefix": "Dr.",
        "credential": "DNP, PHD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-07-10",
        "last_updated": "2024-10-02",
        "certification_date": "2024-10-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "UT",
            "license": "11996960-4405",
            "primary": false
        },
        {
            "code": "163WP0809X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Psychiatric/Mental Health, Adult",
            "state": "WA",
            "license": "RN00164186",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "WA",
            "license": "AP60045999",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Olympia, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.