Individual provider Active NPI

Jeanne M. Gibian, RN, CPNP

  • Pediatric Nurse Practitioner
  • Prescott, AZ
National Provider Identifier
1700956703
Registry record updated Feb 17, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Nurse PractitionerTaxonomy code 363LP0200X
License
AP1307 Issued in AZ
Practice address
2120 Centerpointe West Dr
Prescott, AZ 86301-8487
Phone
(928) 778-4581
Fax
(928) 776-1872
NPI assigned
Nov 8, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 17, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Registered Nurse 163WP0200X RN14260 AZ
Pediatric Nurse Practitioner 363LP0200X AP1307 AZ Primary

Addresses

Primary practice location

2120 Centerpointe West Dr
Prescott, AZ 86301-8487

Mailing address

PO Box 10880
Prescott, AZ 86304-0880
Phone (602) 406-4786

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20231130001086 AZ Practitioner - Nurse Practitioner 7517315617 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Pediatric Nurse Practitioner, Nurse Practitioner, Registered Nurse

State licenses

LicenseStateTypeSpecialty
RN14260AZMDPediatric Registered Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
Yavapai Regional Medical Center Physician Care LLC Current Accepting new patients
Yavapai Regional Medical Center Physician Care LLC CurrentSince Nov 30, 2023 Accepting new patients
Prescott Gastroenterology Past Accepting new patients

Locations

3120 Clearwater Dr
Prescott, AZ 86305
Phone (928) 445-4818

2120 Centerpointe West Dr
Prescott, AZ 86301
Phone (928) 778-4581

Interoperability endpoints

  • Direct secure messaging: jeanne.m.gibian@direct.yrmc.org

Organizations & group practices 3

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

NPI Registry JSON

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

{
    "created_epoch": "1162944000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1739750400000",
    "number": "1700956703",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 10880",
            "city": "PRESCOTT",
            "state": "AZ",
            "postal_code": "863040880",
            "telephone_number": "602-406-4786",
            "fax_number": "916-636-4358"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2120 CENTERPOINTE WEST DR",
            "city": "PRESCOTT",
            "state": "AZ",
            "postal_code": "863018487",
            "telephone_number": "928-778-4581",
            "fax_number": "928-776-1872"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GIBIAN",
        "first_name": "JEANNE",
        "middle_name": "M.",
        "name_prefix": "Mrs.",
        "credential": "RN, CPNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-08",
        "last_updated": "2025-02-17",
        "certification_date": "2025-02-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WP0200X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Pediatrics",
            "state": "AZ",
            "license": "RN14260",
            "primary": false
        },
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "AZ",
            "license": "AP1307",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Prescott, AZ

Sources for this page

Verify at the official NPI Registry.