Provider Demographics
NPI:1346563145
Name:GIBBS, CARLA DIANE (PA-C)
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:DIANE
Last Name:GIBBS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:CARLA
Other - Middle Name:DIANE
Other - Last Name:COUCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:2701 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77901-5748
Mailing Address - Country:US
Mailing Address - Phone:361-573-9181
Mailing Address - Fax:361-572-5126
Practice Address - Street 1:2701 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77901-5748
Practice Address - Country:US
Practice Address - Phone:361-573-9181
Practice Address - Fax:361-572-5126
Is Sole Proprietor?:No
Enumeration Date:2010-03-08
Last Update Date:2011-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA06556363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX213213601Medicaid
TX8L26631OtherMEDICARE PTAN
TX821N72OtherBLUE CROSS