Provider Demographics
NPI:1811694482
Name:GIBSON, DEBRA K (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:K
Last Name:GIBSON
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:11112 E CHESTNUT CT
Mailing Address - Street 2:
Mailing Address - City:SUN LAKES
Mailing Address - State:AZ
Mailing Address - Zip Code:85248-8244
Mailing Address - Country:US
Mailing Address - Phone:480-570-1339
Mailing Address - Fax:
Practice Address - Street 1:2242 W SOUTHERN AVE
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85202-4704
Practice Address - Country:US
Practice Address - Phone:480-750-0095
Practice Address - Fax:480-750-0097
Is Sole Proprietor?:No
Enumeration Date:2023-02-14
Last Update Date:2024-06-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ287174363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health