Provider Demographics
NPI:1164045415
Name:GIPSON, DANYELL S
Entity Type:Individual
Prefix:
First Name:DANYELL
Middle Name:S
Last Name:GIPSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DANYELL
Other - Middle Name:S
Other - Last Name:GIPSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSGIPSON
Mailing Address - Street 1:9403 MANSFIELD RD
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71118-3815
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1110 HOMER RD
Practice Address - Street 2:
Practice Address - City:MINDEN
Practice Address - State:LA
Practice Address - Zip Code:71055-3028
Practice Address - Country:US
Practice Address - Phone:318-382-9700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-21
Last Update Date:2020-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator