Healthcare Provider Details

I. General information

NPI: 1154953107
Provider Name (Legal Business Name): BRIAN GIBBS FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/07/2020
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1540 APPLING CARE LN STE 100
CORDOVA TN
38016-4947
US

IV. Provider business mailing address

1393 HIGHWAY 51 S
HERNANDO MS
38632-1149
US

V. Phone/Fax

Practice location:
  • Phone: 901-202-0735
  • Fax:
Mailing address:
  • Phone: 901-626-9846
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number27083
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number903739
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: