Sallie Ann McKibben, LAC

Primary specialty

AcupuncturistTaxonomy code 171100000X

License

AC164979 Issued in OR

Practice address

5939 SE Belmont St Ste C
Portland, OR 97215-1994

Phone

(503) 468-7210

Fax

(503) 468-5943

NPI assigned

May 8, 2014

Last updated

Jul 30, 2018By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Iris Acupuncture Clinic LLC

  • Acupuncturist
  • Portland, OR
  • NPI 1063395044
  NPD Authorized official

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

{
    "created_epoch": "1399507200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1532908800000",
    "number": "1124439492",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5939 SE BELMONT ST STE C",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972151994",
            "telephone_number": "503-468-7210",
            "fax_number": "503-468-5943"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5939 SE BELMONT ST STE C",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972151994",
            "telephone_number": "503-468-7210",
            "fax_number": "503-468-5943"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "16144 SE Happy Valley Town Center Dr",
            "address_2": "Suite 214",
            "address_purpose": "LOCATION",
            "city": "Happy Valley",
            "state": "OR",
            "postal_code": "970864257",
            "country_code": "US",
            "telephone_number": "503-658-7715",
            "fax_number": "503-658-7181",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MCKIBBEN",
        "first_name": "SALLIE",
        "middle_name": "ANN",
        "name_prefix": "Ms.",
        "credential": "LAC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-05-08",
        "last_updated": "2018-07-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171100000X",
            "taxonomy_group": "",
            "desc": "Acupuncturist",
            "state": "OR",
            "license": "AC164979",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500696042",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kerianne McKeon, PA-C
• Nathanael J McKeown, D.O.
• Jeremiah F McKessey, CRM, PSS, QMHA-R
• Christopher James McKethan, RN
• Natasha Sue McKibben
• Karen Julie McKibbin, PSY.D.
• Peter McKie
• Eryn Claire McKim, RN
• Juliane McKim, RN, PMHNP
• Anthony McKinley

• Acupuncturist in Portland, OR
• Providers in Portland, OR by specialty
• Acupuncturist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 30, 2018; 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.