Healthcare Provider Details

I. General information

NPI: 1033075478
Provider Name (Legal Business Name): JASON GIBSON RN, BSN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/30/2025
Last Update Date: 12/30/2025
Certification Date: 12/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 WASHINGTON ST
BRAINTREE MA
02184-7599
US

IV. Provider business mailing address

44 DEXTER RD
ROCKLAND MA
02370-2022
US

V. Phone/Fax

Practice location:
  • Phone: 617-847-1950
  • Fax:
Mailing address:
  • Phone: 508-958-0120
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRN2274270
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: