Provider Demographics
NPI:1053330449
Name:GIBSON, SAMMIE S (DO)
Entity Type:Individual
Prefix:
First Name:SAMMIE
Middle Name:S
Last Name:GIBSON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 265
Mailing Address - Street 2:
Mailing Address - City:PRESTONSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:41653-0265
Mailing Address - Country:US
Mailing Address - Phone:606-889-6160
Mailing Address - Fax:606-889-6161
Practice Address - Street 1:5000 KY ROUTE 321
Practice Address - Street 2:SUITE 2127
Practice Address - City:PRESTONSBURG
Practice Address - State:KY
Practice Address - Zip Code:41653-9113
Practice Address - Country:US
Practice Address - Phone:606-889-6160
Practice Address - Fax:606-889-6161
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2012-10-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY02957207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology