Provider Demographics
NPI:1952870693
Name:GIBSON, KATHRYN LYNNE (ND)
Entity Type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:LYNNE
Last Name:GIBSON
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10090 MAIN ST APT H
Mailing Address - Street 2:
Mailing Address - City:PESHASTIN
Mailing Address - State:WA
Mailing Address - Zip Code:98847-9770
Mailing Address - Country:US
Mailing Address - Phone:509-881-0722
Mailing Address - Fax:
Practice Address - Street 1:10090 MAIN ST APT H
Practice Address - Street 2:
Practice Address - City:PESHASTIN
Practice Address - State:WA
Practice Address - Zip Code:98847-9770
Practice Address - Country:US
Practice Address - Phone:509-881-0722
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-23
Last Update Date:2019-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANT60907127175F00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No175F00000XOther Service ProvidersNaturopath