Provider Demographics
NPI:1437404498
Name:GIPSON, JOSHUA JENNINGS (BA)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:JENNINGS
Last Name:GIPSON
Suffix:
Gender:M
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 E NORTHERN LIGHTS BLVD
Mailing Address - Street 2:SUITE 211
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99503-2814
Mailing Address - Country:US
Mailing Address - Phone:907-333-4343
Mailing Address - Fax:907-333-4383
Practice Address - Street 1:401 E NORTHERN LIGHTS BLVD
Practice Address - Street 2:SUITE 211
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-2814
Practice Address - Country:US
Practice Address - Phone:907-333-4343
Practice Address - Fax:907-333-4383
Is Sole Proprietor?:No
Enumeration Date:2012-07-16
Last Update Date:2012-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator