Provider Demographics
NPI:1972857860
Name:GIBSON, KATHLEEN ALVAREZ (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:ALVAREZ
Last Name:GIBSON
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:ANN
Other - Last Name:ALVAREZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1300 HOSPITAL DR
Mailing Address - Street 2:SUITE 270
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-3261
Mailing Address - Country:US
Mailing Address - Phone:843-884-5133
Mailing Address - Fax:843-849-3343
Practice Address - Street 1:1300 HOSPITAL DR
Practice Address - Street 2:SUITE 270
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-3261
Practice Address - Country:US
Practice Address - Phone:843-884-5133
Practice Address - Fax:843-849-3343
Is Sole Proprietor?:No
Enumeration Date:2012-10-31
Last Update Date:2012-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC18039363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health