Provider Demographics
NPI:1750193637
Name:GIBSON, KRISTEN BROOKE
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:BROOKE
Last Name:GIBSON
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 1:143 HIGHLAND DR
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:VA
Mailing Address - Zip Code:24266-7145
Mailing Address - Country:US
Mailing Address - Phone:276-889-8081
Mailing Address - Fax:
Practice Address - Street 1:143 HIGHLAND DR
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:VA
Practice Address - Zip Code:24266-7145
Practice Address - Country:US
Practice Address - Phone:276-889-8081
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-27
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator