Provider Demographics
NPI:1104542901
Name:GIBBS, KAYLA SUE I
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:SUE
Last Name:GIBBS
Suffix:I
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 1:1282 INDEPENDENCE CIR SE
Mailing Address - Street 2:
Mailing Address - City:NEW PHILADELPHIA
Mailing Address - State:OH
Mailing Address - Zip Code:44663-9334
Mailing Address - Country:US
Mailing Address - Phone:330-407-5017
Mailing Address - Fax:
Practice Address - Street 1:1282 INDEPENDENCE CIR SE
Practice Address - Street 2:
Practice Address - City:NEW PHILADELPHIA
Practice Address - State:OH
Practice Address - Zip Code:44663-9334
Practice Address - Country:US
Practice Address - Phone:330-407-5017
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-13
Last Update Date:2022-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant