Healthcare Provider Details

I. General information

NPI: 1114262805
Provider Name (Legal Business Name): PATSY G GIBSON B.S.W.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/06/2012
Last Update Date: 12/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 W I 240 SERVICE RD.
OKLAHOMA CITY OK
73139-7701
US

IV. Provider business mailing address

301 W I 240
OKLAHOMA CITY OK
73139
US

V. Phone/Fax

Practice location:
  • Phone: 405-635-3868
  • Fax: 405-604-9689
Mailing address:
  • Phone: 405-635-3868
  • Fax: 405-604-9689

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: