Provider Demographics
NPI:1831883115
Name:GIBSON, GAGE ALLEN
Entity type:Individual
Prefix:
First Name:GAGE
Middle Name:ALLEN
Last Name:GIBSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1102B BROADWAY AVE
Mailing Address - Street 2:
Mailing Address - City:PARKERSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26101-6726
Mailing Address - Country:US
Mailing Address - Phone:681-315-5275
Mailing Address - Fax:
Practice Address - Street 1:1102B BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:PARKERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26101-6726
Practice Address - Country:US
Practice Address - Phone:681-315-5275
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-08
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant