Provider Demographics
NPI:1912176090
Name:GIBSON, MARY HOPE (PHD, BC, FNP)
Entity Type:Individual
Prefix:PROF
First Name:MARY
Middle Name:HOPE
Last Name:GIBSON
Suffix:
Gender:F
Credentials:PHD, BC, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BOX 6964
Mailing Address - Street 2:RADFORD UNIVERSITY, JEFFERSON STREET
Mailing Address - City:RADFORD
Mailing Address - State:VA
Mailing Address - Zip Code:24142
Mailing Address - Country:US
Mailing Address - Phone:540-831-7653
Mailing Address - Fax:540-831-7716
Practice Address - Street 1:MOFFETT HALL ADAMS STREET
Practice Address - Street 2:RADFORD UNIVERSITY STUDENT HEALTH
Practice Address - City:RADFORD
Practice Address - State:VA
Practice Address - Zip Code:24142
Practice Address - Country:US
Practice Address - Phone:540-831-7653
Practice Address - Fax:540-831-7716
Is Sole Proprietor?:No
Enumeration Date:2008-02-22
Last Update Date:2008-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0017137239363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily