Provider Demographics
NPI:1740877893
Name:GIBSON, JENNIFER B (MS, PA-C)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:B
Last Name:GIBSON
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Gender:
Credentials:MS, PA-C
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Other - Credentials:
Mailing Address - Street 1:2645 NALL ST
Mailing Address - Street 2:
Mailing Address - City:PORT NECHES
Mailing Address - State:TX
Mailing Address - Zip Code:77651-4707
Mailing Address - Country:US
Mailing Address - Phone:409-210-3336
Mailing Address - Fax:
Practice Address - Street 1:2645 NALL ST
Practice Address - Street 2:
Practice Address - City:PORT NECHES
Practice Address - State:TX
Practice Address - Zip Code:77651-4707
Practice Address - Country:US
Practice Address - Phone:409-210-3336
Practice Address - Fax:409-527-3969
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-23
Last Update Date:2025-03-04
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant