Provider Demographics
NPI:1558853457
Name:GIBSON, JOCELYN ELYSE (PA-C)
Entity Type:Individual
Prefix:
First Name:JOCELYN
Middle Name:ELYSE
Last Name:GIBSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5329 COUNTRYSIDE CIR
Mailing Address - Street 2:
Mailing Address - City:JEFFERSONTON
Mailing Address - State:VA
Mailing Address - Zip Code:22724-1805
Mailing Address - Country:US
Mailing Address - Phone:540-272-9032
Mailing Address - Fax:
Practice Address - Street 1:430 BOXWOOD LN
Practice Address - Street 2:
Practice Address - City:PEARISBURG
Practice Address - State:VA
Practice Address - Zip Code:24134-1168
Practice Address - Country:US
Practice Address - Phone:540-921-6110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-06
Last Update Date:2021-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical