Provider Demographics
NPI:1801582457
Name:GIPSON, CAROLYN JEAN (APRN)
Entity type:Individual
Prefix:MS
First Name:CAROLYN
Middle Name:JEAN
Last Name:GIPSON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:KRIS
Other - Middle Name:
Other - Last Name:GIPSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:APRN, FNP-BC
Mailing Address - Street 1:6801 ROGERS AVE STE 5TH
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72903-4067
Mailing Address - Country:US
Mailing Address - Phone:479-274-2801
Mailing Address - Fax:
Practice Address - Street 1:6801 ROGERS AVE STE 5TH
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-4067
Practice Address - Country:US
Practice Address - Phone:479-274-2801
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-17
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR223676363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily