Provider Demographics
NPI:1407535685
Name:GIBSON, ELAYNA BROOKE (PA-C)
Entity Type:Individual
Prefix:
First Name:ELAYNA
Middle Name:BROOKE
Last Name:GIBSON
Suffix:
Gender:F
Credentials:PA-C
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Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2315 GLENMARY AVE APT F1
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40204-2153
Mailing Address - Country:US
Mailing Address - Phone:859-797-1722
Mailing Address - Fax:
Practice Address - Street 1:3321 BALLARD LN
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:IN
Practice Address - Zip Code:47150-7267
Practice Address - Country:US
Practice Address - Phone:812-944-4575
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-14
Last Update Date:2023-07-14
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical