Provider Demographics
NPI:1033505334
Name:GIBBS, KAYLA RENEA
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:RENEA
Last Name:GIBBS
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 1:407 8TH ST LOT 4
Mailing Address - Street 2:
Mailing Address - City:BELPRE
Mailing Address - State:OH
Mailing Address - Zip Code:45714-1681
Mailing Address - Country:US
Mailing Address - Phone:740-629-7735
Mailing Address - Fax:
Practice Address - Street 1:407 8TH ST LOT 4
Practice Address - Street 2:
Practice Address - City:BELPRE
Practice Address - State:OH
Practice Address - Zip Code:45714-1681
Practice Address - Country:US
Practice Address - Phone:740-629-7735
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-13
Last Update Date:2015-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHUG045357374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0112822Medicaid