Provider Demographics
NPI:1023395860
Name:GIPSON, SHONE DARNELL (ATC)
Entity Type:Individual
Prefix:MR
First Name:SHONE
Middle Name:DARNELL
Last Name:GIPSON
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5800 AIRLINE DRIVE
Mailing Address - Street 2:
Mailing Address - City:METAIRE
Mailing Address - State:LA
Mailing Address - Zip Code:70003
Mailing Address - Country:US
Mailing Address - Phone:716-983-2294
Mailing Address - Fax:
Practice Address - Street 1:5800 AIRLINE DRIVE
Practice Address - Street 2:
Practice Address - City:METAIRE
Practice Address - State:LA
Practice Address - Zip Code:70003
Practice Address - Country:US
Practice Address - Phone:716-983-2294
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-08
Last Update Date:2021-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0012042255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer