Active NPI
Andrea Kay Shibles
- Peer Specialist
- Eugene, OR
National Provider Identifier
1265212534
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Peer Specialist
- License
- 109638
- Practice address
- 315 Coburg Rd Ste C
Eugene, OR 97401-6114 - Phone
- (541) 505-9190
- Fax
- (541) 505-9264
- NPI assigned
- Oct 3, 2023
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Peer Specialist | 175T00000X | 109638 | OR | Primary |
Addresses
Primary practice location
315 Coburg Rd Ste C
Eugene, OR 97401-6114
Mailing address
315 Coburg Rd Ste C
Eugene, OR 97401-6114
Phone (541) 505-9190
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 109638 | OR | MD | Peer Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1696291200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1696291200000",
"number": "1265212534",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "315 COBURG RD STE C",
"city": "EUGENE",
"state": "OR",
"postal_code": "974016114",
"telephone_number": "541-505-9190",
"fax_number": "541-505-9264"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "315 COBURG RD STE C",
"city": "EUGENE",
"state": "OR",
"postal_code": "974016114",
"telephone_number": "541-505-9190",
"fax_number": "541-505-9264"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHIBLES",
"first_name": "ANDREA",
"middle_name": "KAY",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-10-03",
"last_updated": "2023-10-03",
"certification_date": "2023-10-03",
"status": "A"
},
"taxonomies": [
{
"code": "175T00000X",
"taxonomy_group": "",
"desc": "Peer Specialist",
"state": "OR",
"license": "109638",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Eugene, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 3, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.