Provider Demographics
NPI:1487212585
Name:GIPSON, LESIA DENISE
Entity Type:Individual
Prefix:MISS
First Name:LESIA
Middle Name:DENISE
Last Name:GIPSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:375A LOVE CV
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:MS
Mailing Address - Zip Code:39042-8320
Mailing Address - Country:US
Mailing Address - Phone:601-966-4564
Mailing Address - Fax:
Practice Address - Street 1:375A LOVE CV
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:MS
Practice Address - Zip Code:39042-8320
Practice Address - Country:US
Practice Address - Phone:601-966-4564
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-03
Last Update Date:2019-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSP235121164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS164W00000XOtherIN HOME SENIOR CARE
MS841950454Other164W00000X
841950454OtherIN HOME SENIOR CARE