MEDICARE: RHONDA LYNN GIBSON FNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	APRN.CNP.0030735	OH

General Provider Information

NPI Number	:	1265187660
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RHONDA LYNN GIBSON FNP-BC

Provider Business Mailing Address
First Line	:	1642 STATE ROUTE 133
Second Line	:
City	:	BETHEL
State	:	OH
Zip	:	45106-9415
Country	:	US
Telephone Number	:	513-638-5916
Fax Number	:

Provider Business Practice Location Address
First Line	:	217 HUGHES BLVD
Second Line	:
City	:	MOUNT ORAB
State	:	OH
Zip	:	45154-8356
Country	:	US
Telephone Number	:	937-386-6942
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/15/2022
Last Update Date	:	03/25/2024

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