Provider Demographics
NPI:1669012423
Name:GIBBS, TIFFANY KATHLEEN
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:KATHLEEN
Last Name:GIBBS
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 1:6655 LYNN RD
Mailing Address - Street 2:
Mailing Address - City:BELL CITY
Mailing Address - State:LA
Mailing Address - Zip Code:70630-4015
Mailing Address - Country:US
Mailing Address - Phone:337-396-2539
Mailing Address - Fax:
Practice Address - Street 1:2492 S CITIES SERVICE HWY STE 1
Practice Address - Street 2:
Practice Address - City:SULPHUR
Practice Address - State:LA
Practice Address - Zip Code:70665-6497
Practice Address - Country:US
Practice Address - Phone:337-905-1962
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-09
Last Update Date:2020-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP10186363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily