Healthcare Provider Details

I. General information

NPI: 1164840690
Provider Name (Legal Business Name): KRYSTAL A GIBBS CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2014
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 E 2ND ST
COUDERSPORT PA
16915-8161
US

IV. Provider business mailing address

1810 APPLE DR
FAIRVIEW PA
16415-1909
US

V. Phone/Fax

Practice location:
  • Phone: 814-274-0300
  • Fax:
Mailing address:
  • Phone: 814-602-2034
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN615814
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: