Provider Demographics
NPI:1497850929
Name:GIBBS, JODI L (PA-C)
Entity Type:Individual
Prefix:
First Name:JODI
Middle Name:L
Last Name:GIBBS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:JODI
Other - Middle Name:L
Other - Last Name:BALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5450 FRANTZ RD
Mailing Address - Street 2:SUITE 250
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43016-4134
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3555 OLENTANGY RIVER RD
Practice Address - Street 2:SUITE 2020
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214-3912
Practice Address - Country:US
Practice Address - Phone:614-566-2280
Practice Address - Fax:614-533-0124
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.001732363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH50.001732OtherOHIO PA LICENSE
OHGIPA27203Medicare PIN
OHH109250Medicare PIN
OHQ70892Medicare UPIN
OHGIPA27202Medicare PIN
OHGIPA27201Medicare PIN