Healthcare Provider Details

I. General information

NPI: 1932090792
Provider Name (Legal Business Name): ALEXIA GIBSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2025
Last Update Date: 11/06/2025
Certification Date: 11/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2614 CHARLESTOWN RD
NEW ALBANY IN
47150
US

IV. Provider business mailing address

2785 CASON ST
LAFAYETTE IN
47904-2843
US

V. Phone/Fax

Practice location:
  • Phone: 930-204-2414
  • Fax: 855-915-0244
Mailing address:
  • Phone: 317-502-3512
  • Fax: 855-915-0244

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-25-444181
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: