Healthcare Provider Details

I. General information

NPI: 1306866074
Provider Name (Legal Business Name): GRACE A GIBBS DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 10/15/2024
Certification Date: 10/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1306 VERSAILLES RD STE 120
LEXINGTON KY
40504-1795
US

IV. Provider business mailing address

1306 VERSAILLES RD STE 120
LEXINGTON KY
40504-1795
US

V. Phone/Fax

Practice location:
  • Phone: 859-259-2635
  • Fax:
Mailing address:
  • Phone: 859-259-2635
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number5101015015
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: