Basic Information
Provider Information | |||||||||
NPI: | 1427158252 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | GIBSON | ||||||||
FirstName: | GAIL | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | CRNA | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 76 PEACHTREE ROAD | ||||||||
Address2: | SUITE 300 | ||||||||
City: | ASHEVILLE | ||||||||
State: | NC | ||||||||
PostalCode: | 288033505 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8282743477 | ||||||||
FaxNumber: | 8282747407 | ||||||||
Practice Location | |||||||||
Address1: | 76 PEACHTREE ROAD | ||||||||
Address2: | SUITE 300 | ||||||||
City: | ASHEVILLE | ||||||||
State: | NC | ||||||||
PostalCode: | 288033505 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8282743477 | ||||||||
FaxNumber: | 8282747407 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 09/22/2006 | ||||||||
LastUpdateDate: | 12/11/2013 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | 179166 | NC | Y |   | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |   |
ID Information
ID | Type | State | Issuer | Description | 260557 | 01 | NC | CIGNA MEDICARE | OTHER | 430079565 | 01 | NC | SWAIN RAILROAD CRNA | OTHER | 430065529 | 01 | NC | HARRIS RAILROAD CRNA | OTHER | 8000315 | 05 | NY |   | MEDICAID | 8051709 | 01 | NC | EDS PROVIDER NO | OTHER | 179166 | 01 | NC | LICENSE NUMBER | OTHER | 2601638 | 01 | NC | PART B CIGNA | OTHER | 8000180 | 05 | NY |   | MEDICAID |