Provider Demographics
NPI:1669130100
Name:GIBBY, TERESA ANN (LICENSED PRACTICAL N)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:ANN
Last Name:GIBBY
Suffix:
Gender:F
Credentials:LICENSED PRACTICAL N
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2855 OLD HIGHWAY 5 STE 111
Mailing Address - Street 2:
Mailing Address - City:BLUE RIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30513-6239
Mailing Address - Country:US
Mailing Address - Phone:706-632-4215
Mailing Address - Fax:706-946-4251
Practice Address - Street 1:2855 OLD HIGHWAY 5 STE 111
Practice Address - Street 2:
Practice Address - City:BLUE RIDGE
Practice Address - State:GA
Practice Address - Zip Code:30513-6239
Practice Address - Country:US
Practice Address - Phone:706-632-4215
Practice Address - Fax:706-946-4251
Is Sole Proprietor?:No
Enumeration Date:2021-12-01
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC090478164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse