Basic Information
| Provider Information | |||||||||
| NPI: | 1386891950 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GIBNEY | ||||||||
| FirstName: | JESSICA | ||||||||
| MiddleName: | ANN | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 457 19TH AVE CIRCLE NW | ||||||||
| Address2: | |||||||||
| City: | HICKORY | ||||||||
| State: | NC | ||||||||
| PostalCode: | 28601 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4343857818 | ||||||||
| FaxNumber: | 8283450350 | ||||||||
| Practice Location | |||||||||
| Address1: | 457 19TH AVENUE NW | ||||||||
| Address2: | |||||||||
| City: | HICKORY | ||||||||
| State: | NC | ||||||||
| PostalCode: | 28601 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4343857818 | ||||||||
| FaxNumber: | 8283450350 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/26/2008 | ||||||||
| LastUpdateDate: | 01/05/2016 | ||||||||
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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 | 207V00000X | 201501870 | NC | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 1386891950 | 05 | VA | MEDICAID |