Provider Demographics
NPI:1871192633
Name:GIBBONS, ANGELA LYNN (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:LYNN
Last Name:GIBBONS
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1334 N HARVILLE RD
Mailing Address - Street 2:
Mailing Address - City:DUNCAN
Mailing Address - State:OK
Mailing Address - Zip Code:73533-1514
Mailing Address - Country:US
Mailing Address - Phone:580-255-8564
Mailing Address - Fax:580-255-8640
Practice Address - Street 1:1334 N HARVILLE RD
Practice Address - Street 2:
Practice Address - City:DUNCAN
Practice Address - State:OK
Practice Address - Zip Code:73533-1514
Practice Address - Country:US
Practice Address - Phone:580-255-8564
Practice Address - Fax:580-255-8640
Is Sole Proprietor?:No
Enumeration Date:2020-10-22
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK4445207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine