Provider Demographics
NPI:1932344116
Name:GIBSON, RACHELE ANN (MD, MSPH)
Entity Type:Individual
Prefix:DR
First Name:RACHELE
Middle Name:ANN
Last Name:GIBSON
Suffix:
Gender:F
Credentials:MD, MSPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1203 S TYLER ST STE 200
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433-2353
Mailing Address - Country:US
Mailing Address - Phone:985-892-9143
Mailing Address - Fax:
Practice Address - Street 1:1203 S TYLER ST STE 200
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-2353
Practice Address - Country:US
Practice Address - Phone:985-892-9143
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-02
Last Update Date:2020-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN8296207RP1001X, 207RP1001X, 207R00000X, 207RP1001X
LA310114207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA310114OtherLICENSE
TX285945602Medicaid
TX438870YKTUMedicare PIN
TX438870YKTVMedicare PIN
MNP01168300OtherRAILROAD MEDICARE
TX438870YKTXMedicare PIN
MNP01168300OtherRAILROAD MEDICARE
TX438870YKTXMedicare PIN