Healthcare Provider Details

I. General information

NPI: 1669055802
Provider Name (Legal Business Name): MEGHAN AUDRA GIBSON CLINE DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/05/2021
Last Update Date: 07/08/2025
Certification Date: 07/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9601 BAPTIST HEALTH DR STE 1B
LITTLE ROCK AR
72205-6321
US

IV. Provider business mailing address

422 BEECHWOOD ST
LITTLE ROCK AR
72205-3818
US

V. Phone/Fax

Practice location:
  • Phone: 501-202-2093
  • Fax: 501-202-6316
Mailing address:
  • Phone: 918-440-5529
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberE-19392
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License NumberE-19392
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: