Healthcare Provider Details

I. General information

NPI: 1821342320
Provider Name (Legal Business Name): SARAH CHRISTINE GIBBLE PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/05/2012
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10506 MONTGOMERY RD STE 301A
MONTGOMERY OH
45242-4400
US

IV. Provider business mailing address

10506A MONTGOMERY RD STE 301
MONTGOMERY OH
45242-4402
US

V. Phone/Fax

Practice location:
  • Phone: 513-246-2400
  • Fax: 513-985-2905
Mailing address:
  • Phone: 513-246-2400
  • Fax: 513-985-2905

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number003578
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50.003578RX
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: