Provider Demographics
NPI:1205817301
Name:GIBSON, DEBRA LYNN (ARNP)
Entity Type:Individual
Prefix:MS
First Name:DEBRA
Middle Name:LYNN
Last Name:GIBSON
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6239 ZEBULON HWY
Mailing Address - Street 2:
Mailing Address - City:PIKEVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41501-3581
Mailing Address - Country:US
Mailing Address - Phone:606-631-3122
Mailing Address - Fax:
Practice Address - Street 1:119 RIVER DR
Practice Address - Street 2:
Practice Address - City:PIKEVILLE
Practice Address - State:KY
Practice Address - Zip Code:41501-1685
Practice Address - Country:US
Practice Address - Phone:606-437-5500
Practice Address - Fax:606-433-9690
Is Sole Proprietor?:No
Enumeration Date:2005-11-07
Last Update Date:2007-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2243P363LW0102X
KY1048697363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY20098018Medicaid
KY000000225676OtherANTHEM
KY1197102OtherCHA
KY20098018Medicaid