Provider Demographics
NPI:1376503227
Name:GIBSON, MARGUERITE M (ARNP)
Entity Type:Individual
Prefix:
First Name:MARGUERITE
Middle Name:M
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 1:3173 KIRBY WHITTEN RD
Mailing Address - Street 2:STE 104
Mailing Address - City:BARTLETT
Mailing Address - State:TN
Mailing Address - Zip Code:38134-2881
Mailing Address - Country:US
Mailing Address - Phone:901-384-8040
Mailing Address - Fax:901-309-8784
Practice Address - Street 1:3645 E MCLEOD RD
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98226-8700
Practice Address - Country:US
Practice Address - Phone:360-676-2220
Practice Address - Fax:360-676-7750
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2017-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN18049363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9634676Medicaid
WA9634676Medicaid
P05352Medicare UPIN