Doctor Name: | MRS. ALYCIA D GIBSON |
NPI Number: | 1073544516 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PAC |
License Number: | 0000001274 |
Business Practice Address: | 405 Tyson Ave Ste B Grace Clinic, Inc Paris, TN - 382424836 |
Business Phone Number: | 7316443339 |
Business Fax Number: | 7316449930 |
Mailing Address: | 4407 Highway 140 S, MC KENZIE |
State: | TN |
Postal Code: | 382015121 |
Phone Number: | 7312434826 |
Fax Number: | |
NPI Enumeration Date: | 07/05/2006 |
NPI Last Update Date: | 07/29/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363AM0700X |
License Number: | 0000001274 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | TN |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Physician Assistant |
Taxonomy Specialization: | Medical |
Taxonomy Definition: |