Provider Demographics
NPI:1407840473
Name:GIBSON, TERESA D (ANP GNP)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:D
Last Name:GIBSON
Suffix:
Gender:F
Credentials:ANP GNP
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 7200
Mailing Address - Street 2:
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:NC
Mailing Address - Zip Code:27804-0200
Mailing Address - Country:US
Mailing Address - Phone:252-451-3200
Mailing Address - Fax:252-937-6278
Practice Address - Street 1:91 ENTERPRISE DR
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27804
Practice Address - Country:US
Practice Address - Phone:252-451-3200
Practice Address - Fax:252-937-3107
Is Sole Proprietor?:No
Enumeration Date:2005-09-07
Last Update Date:2019-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC600092363LG0600X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1850COtherBCBS OF NC
NC500005758OtherRAILROAD MEDICARE
NC7000423Medicaid
NCC80719Medicare UPIN