Provider Demographics
NPI:1013022938
Name:GIBSON, BRANDI DAWN
Entity Type:Individual
Prefix:MRS
First Name:BRANDI
Middle Name:DAWN
Last Name:GIBSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2713 NW 158TH ST
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-8819
Mailing Address - Country:US
Mailing Address - Phone:405-348-8071
Mailing Address - Fax:
Practice Address - Street 1:600 NW 23RD ST
Practice Address - Street 2:SUITE 101
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73103-1469
Practice Address - Country:US
Practice Address - Phone:405-232-2437
Practice Address - Fax:405-232-2447
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program