NPI 1477411239 · live from the CMS NPI Registry
Jacob Ryan Gibson
Registered Nurse, Psych/Mental Health, Adult in Portland, OR. National Provider Identifier 1477411239, active.
NPI record
| NPI | 1477411239 Type 1 · individual |
|---|---|
| Status | Active |
| Primary specialty | Registered Nurse, Psych/Mental Health, Adult 163WP0809X |
| Practice location | 17720 Ne Halsey St Ste A, Portland, OR 97230 |
| Practice phone | 503-654-7654 |
| Mailing address | 3587 Heathrow Way, Medford, OR 97504 |
| Enumerated | January 12, 2026 |
| Last updated | January 13, 2026 |
| Sole proprietor | No |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Registered Nurse, Psych/Mental Health, Adult primary | 163WP0809X | 10051976 (OR) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.