Provider Demographics
NPI:1225202864
Name:GIBBONEY, WILLIAM BRYAN (DNP, FNP-C, ACNP-BC)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:BRYAN
Last Name:GIBBONEY
Suffix:
Gender:M
Credentials:DNP, FNP-C, ACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6699 OLD FORT BAYOU RD
Mailing Address - Street 2:
Mailing Address - City:OCEAN SPRINGS
Mailing Address - State:MS
Mailing Address - Zip Code:39564-7987
Mailing Address - Country:US
Mailing Address - Phone:228-872-4349
Mailing Address - Fax:
Practice Address - Street 1:1434 CENTRAL AVE E
Practice Address - Street 2:
Practice Address - City:WIGGINS
Practice Address - State:MS
Practice Address - Zip Code:39577-9602
Practice Address - Country:US
Practice Address - Phone:228-436-1191
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-15
Last Update Date:2019-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR861831363LF0000X, 363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS01030384Medicaid
MS512I500588OtherMEDICARE PTAN