Provider Demographics
NPI:1366857823
Name:GIBSON, MICHAY LEE
Entity Type:Individual
Prefix:
First Name:MICHAY
Middle Name:LEE
Last Name:GIBSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MICHAY
Other - Middle Name:LEE
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:34242 CHOCTAW LN
Mailing Address - Street 2:
Mailing Address - City:POTEAU
Mailing Address - State:OK
Mailing Address - Zip Code:74953-5264
Mailing Address - Country:US
Mailing Address - Phone:918-839-2153
Mailing Address - Fax:
Practice Address - Street 1:34242 CHOCTAW LN
Practice Address - Street 2:
Practice Address - City:POTEAU
Practice Address - State:OK
Practice Address - Zip Code:74953-5264
Practice Address - Country:US
Practice Address - Phone:918-839-2153
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-24
Last Update Date:2014-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator