Provider Demographics
NPI:1104363357
Name:RIDER-GIBSON, BRITTANY ALLYSON (PA-C)
Entity Type:Individual
Prefix:
First Name:BRITTANY
Middle Name:ALLYSON
Last Name:RIDER-GIBSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5612 EASTON RD
Mailing Address - Street 2:
Mailing Address - City:PLUMSTEADVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18949-0866
Mailing Address - Country:US
Mailing Address - Phone:215-766-8844
Mailing Address - Fax:
Practice Address - Street 1:5612 EASTON RD
Practice Address - Street 2:
Practice Address - City:PLUMSTEADVILLE
Practice Address - State:PA
Practice Address - Zip Code:18949-0866
Practice Address - Country:US
Practice Address - Phone:215-766-8844
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-26
Last Update Date:2017-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA058840363A00000X
PAOA004053363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant