Provider Demographics
NPI:1043995673
Name:GIPSON, AUSTIN DREW (FNP)
Entity Type:Individual
Prefix:
First Name:AUSTIN
Middle Name:DREW
Last Name:GIPSON
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:319 THOMPSON RD
Mailing Address - Street 2:
Mailing Address - City:WEATHERFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76087-8165
Mailing Address - Country:US
Mailing Address - Phone:817-932-5057
Mailing Address - Fax:
Practice Address - Street 1:9557 N BEACH ST STE 121
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76244-6437
Practice Address - Country:US
Practice Address - Phone:817-741-5050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-20
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1125990363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily