Provider Demographics
NPI:1407347750
Name:GIBBS, JOSEPH DANIEL (NP)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:DANIEL
Last Name:GIBBS
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 434
Mailing Address - Street 2:
Mailing Address - City:ENNIS
Mailing Address - State:MT
Mailing Address - Zip Code:59729-0434
Mailing Address - Country:US
Mailing Address - Phone:317-432-2458
Mailing Address - Fax:
Practice Address - Street 1:8244 E US HIGHWAY 36 STE 1100
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:IN
Practice Address - Zip Code:46123-9627
Practice Address - Country:US
Practice Address - Phone:317-272-7500
Practice Address - Fax:317-272-7515
Is Sole Proprietor?:No
Enumeration Date:2018-05-22
Last Update Date:2021-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT130422363L00000X
IN71009841A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner