Provider Demographics
NPI:1831379940
Name:GIBSON, BARBARA LILLIAN (FNP)
Entity type:Individual
Prefix:
First Name:BARBARA
Middle Name:LILLIAN
Last Name:GIBSON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 REDMOND RD NW
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30165-1534
Mailing Address - Country:US
Mailing Address - Phone:706-290-8009
Mailing Address - Fax:706-236-1902
Practice Address - Street 1:80 REDMOND RD NW
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30165-1534
Practice Address - Country:US
Practice Address - Phone:706-290-8009
Practice Address - Fax:706-236-1902
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-06
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN073501363LF0000X
GARN073501NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily