Healthcare Provider Details

I. General information

NPI: 1326802786
Provider Name (Legal Business Name): LAURA RENNIE GIBSON CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2024
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4951 S WHITE MOUNTAIN RD BLDG A
SHOW LOW AZ
85901-7827
US

IV. Provider business mailing address

104 HARVEST DR
RIDGELAND MS
39157-4012
US

V. Phone/Fax

Practice location:
  • Phone: 928-537-6700
  • Fax: 928-532-8957
Mailing address:
  • Phone: 601-540-0968
  • Fax: 928-532-2198

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number327575
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: