Basic Information
| Provider Information | |||||||||
| NPI: | 1205817301 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GIBSON | ||||||||
| FirstName: | DEBRA | ||||||||
| MiddleName: | LYNN | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | ARNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6239 ZEBULON HWY | ||||||||
| Address2: | |||||||||
| City: | PIKEVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 415013581 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6066313122 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 119 RIVER DR | ||||||||
| Address2: | |||||||||
| City: | PIKEVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 415011685 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6064375500 | ||||||||
| FaxNumber: | 6064339690 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/07/2005 | ||||||||
| LastUpdateDate: | 11/27/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LW0102X | 2243P | KY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Women's Health | 363LW0102X | 1048697 | KY | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Women's Health |
ID Information
| ID | Type | State | Issuer | Description | 20098018 | 05 | KY | MEDICAID | 000000225676 | 01 | KY | ANTHEM | OTHER | 1197102 | 01 | KY | CHA | OTHER |