Provider Demographics
NPI:1659309003
Name:GIBSON, GAYLE (APRN,BC)
Entity Type:Individual
Prefix:
First Name:GAYLE
Middle Name:
Last Name:GIBSON
Suffix:
Gender:F
Credentials:APRN,BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5833 SPOHN DR
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78414-4121
Mailing Address - Country:US
Mailing Address - Phone:361-991-1885
Mailing Address - Fax:361-991-1839
Practice Address - Street 1:5833 SPOHN DR
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78414-4121
Practice Address - Country:US
Practice Address - Phone:361-991-1885
Practice Address - Fax:361-991-1839
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX533345363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics