Provider Demographics
NPI:1568015337
Name:GIBSON, PANDY BETH
Entity Type:Individual
Prefix:
First Name:PANDY
Middle Name:BETH
Last Name:GIBSON
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 1:3285 FERGUSON ST SW
Mailing Address - Street 2:
Mailing Address - City:TUMWATER
Mailing Address - State:WA
Mailing Address - Zip Code:98512-6143
Mailing Address - Country:US
Mailing Address - Phone:360-943-1907
Mailing Address - Fax:360-943-1912
Practice Address - Street 1:3285 FERGUSON ST SW
Practice Address - Street 2:
Practice Address - City:TUMWATER
Practice Address - State:WA
Practice Address - Zip Code:98512-6143
Practice Address - Country:US
Practice Address - Phone:360-252-2989
Practice Address - Fax:360-943-1912
Is Sole Proprietor?:No
Enumeration Date:2019-07-22
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPC61086725246RP1900X
WA60962947101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy