Jocelyn Diane Libby, M.D.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

MD00045260 Issued in WA

Practice address

9555 Upland LN N
Maple Grove, MN 55369-4485

Phone

(952) 993-1440

NPI assigned

Apr 19, 2006

Sex

Female

Sole proprietor

No

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)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1145404800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1626048000000",
    "number": "1841255072",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9555 UPLAND LN N",
            "city": "MAPLE GROVE",
            "state": "MN",
            "postal_code": "553694485",
            "telephone_number": "952-993-1440"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9555 UPLAND LN N",
            "city": "MAPLE GROVE",
            "state": "MN",
            "postal_code": "553694485",
            "telephone_number": "952-993-1440"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "971 11th Ave",
            "address_purpose": "LOCATION",
            "city": "Longview",
            "state": "WA",
            "postal_code": "986322503",
            "country_code": "US",
            "telephone_number": "360-423-6140",
            "fax_number": "360-423-1405",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LIBBY",
        "first_name": "JOCELYN",
        "middle_name": "DIANE",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-04-19",
        "last_updated": "2021-07-12",
        "certification_date": "2021-07-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "WA",
            "license": "MD00045260",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1122423",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Valerie Lessard
• Amalya Lewin-Larin, LGSW
• D Grant Lewis, DDS
• Kristina R Liaugaudas, M.D.
• Amber N Libby, LMFT
• Liberty Oxygen and Home Care, Inc
• Alexandra Lynn Liethen
• Lifehouse Medical Supply, LLC
• Lifeway Health & Wellness LLC
• Jeannine Lilliberg, RN

• Pediatrics Physician in Maple Grove, MN
• Providers in Maple Grove, MN by specialty
• Pediatrics Physician in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 2021; 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.