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NPI Code Detail

MEDICARE: JUDITH GIBSON MSOM, DIPL ACU, LAC

MEDICARE: JUDITH GIBSON MSOM, DIPL ACU, LAC
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
1171100000XAcupuncturist173TN

General Provider Information

NPI Number : 1447863337
Entity Type Code : Individual
Provider Name (Legal Business Name) : JUDITH GIBSON MSOM, DIPL ACU, LAC
Provider Business Mailing Address
First Line : 1040 DEER WOOD TRL
Second Line :
City : PEGRAM
State : TN
Zip : 37143-5061
Country : US
Telephone Number : 608-235-8138
Fax Number :
Provider Business Practice Location Address
First Line : 3808 PARK AVE
Second Line :
City : NASHVILLE
State : TN
Zip : 37209-3741
Country : US
Telephone Number : 615-499-0789
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/28/2020
Last Update Date : 08/28/2020

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