Basic Information
| Provider Information | |||||||||
| NPI: | 1942259601 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HIBBETT | ||||||||
| FirstName: | MARIBETH | ||||||||
| MiddleName: | E. | ||||||||
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| Credential: | APRN | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 635283 | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452635283 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8593015901 | ||||||||
| FaxNumber: | 8593015940 | ||||||||
| Practice Location | |||||||||
| Address1: | 334 THOMAS MORE PARKWAY | ||||||||
| Address2: | |||||||||
| City: | CRESTVIEW HILLS | ||||||||
| State: | KY | ||||||||
| PostalCode: | 410173464 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8593015901 | ||||||||
| FaxNumber: | 8593015940 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/09/2006 | ||||||||
| LastUpdateDate: | 08/30/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WP0808X | 1044830 | KY | N | Nursing Service Providers | Registered Nurse | Psych/Mental Health | 363LP0808X | 3002128 | KY | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health | 363L00000X | 3002128 | KY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 7100177360 | 05 | KY | MEDICAID | 000000041042 | 01 | KY | ANTHEM | OTHER | 262258000 | 01 | KY | MAGELLAN | OTHER | 1195444 | 01 | KY | CHA HEALTH | OTHER | 065805 | 01 | KY | VALUE OPTIONS | OTHER |