Provider Demographics
NPI:1003972282
Name:GIBSON, ANITA DAWN (PA-C)
Entity Type:Individual
Prefix:MS
First Name:ANITA
Middle Name:DAWN
Last Name:GIBSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:9432 KATY FWY
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77055-6349
Mailing Address - Country:US
Mailing Address - Phone:713-333-6490
Mailing Address - Fax:713-464-3209
Practice Address - Street 1:9432 KATY FWY
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77055-6349
Practice Address - Country:US
Practice Address - Phone:713-333-6490
Practice Address - Fax:713-464-3209
Is Sole Proprietor?:No
Enumeration Date:2006-12-29
Last Update Date:2021-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA03854363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant