Healthcare Provider Details

I. General information

NPI: 1508062324
Provider Name (Legal Business Name): VICKI L. GIBBS LPN, MX
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 23RD AVE N RM 311
NASHVILLE TN
37203-1503
US

IV. Provider business mailing address

1831 RIVER DR
NASHVILLE TN
37218-3224
US

V. Phone/Fax

Practice location:
  • Phone: 615-340-5650
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberLPN0000033166
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License NumberMDX0000001736
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: