Healthcare Provider Details

I. General information

NPI: 1053330449
Provider Name (Legal Business Name): SAMMIE S. GIBSON D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23 WILLOW DR
AUXIER KY
41602-9259
US

IV. Provider business mailing address

1709 KY ROUTE 321 STE 3
PRESTONSBURG KY
41653-9097
US

V. Phone/Fax

Practice location:
  • Phone: 606-886-8997
  • Fax: 877-882-7310
Mailing address:
  • Phone: 606-886-8546
  • Fax: 606-886-8548

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number02957
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: