Provider Demographics
NPI:1831954254
Name:GIBSON, SIERRA ASHLEY
Entity type:Individual
Prefix:
First Name:SIERRA
Middle Name:ASHLEY
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 1:1107 S TILLOTSON AVE
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47304-4517
Mailing Address - Country:US
Mailing Address - Phone:765-717-5399
Mailing Address - Fax:855-792-0451
Practice Address - Street 1:1107 S TILLOTSON AVE
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47304-4517
Practice Address - Country:US
Practice Address - Phone:765-717-5399
Practice Address - Fax:855-792-0451
Is Sole Proprietor?:No
Enumeration Date:2024-02-15
Last Update Date:2025-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71015119A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily