| Doctor Name: | ANGELA DENISE GIBSON |
| NPI Number: | 1477941870 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | FNP-C |
| License Number: | R859490 |
| Business Practice Address: | 840 N Oak Ave Ruleville, MS - 387713227 |
| Business Phone Number: | 6627562711 |
| Business Fax Number: | |
| Mailing Address: | Po Box 369, RULEVILLE |
| State: | MS |
| Postal Code: | 387710369 |
| Phone Number: | 6627562711 |
| Fax Number: | |
| NPI Enumeration Date: | 01/07/2015 |
| NPI Last Update Date: | 01/07/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | R859490 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MS |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |