| Doctor Name: | CORENA R GIBSON |
| NPI Number: | 1578546495 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | APRN |
| License Number: | APN6725 |
| Business Practice Address: | 69 S Main St Whitley City, KY - 426536043 |
| Business Phone Number: | 6063767399 |
| Business Fax Number: | 6063767396 |
| Mailing Address: | Po Box 1080, BURKESVILLE |
| State: | KY |
| Postal Code: | 427171080 |
| Phone Number: | 2708641472 |
| Fax Number: | 2708641472 |
| NPI Enumeration Date: | 11/23/2005 |
| NPI Last Update Date: | 09/15/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | APN6725 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | TN |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |