Healthcare Provider Details

I. General information

NPI: 1093647489
Provider Name (Legal Business Name): GRACE MARIE GIBSON APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2026
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1804 HAYES ST
NASHVILLE TN
37203-2504
US

IV. Provider business mailing address

7715 PORTER HOUSE DR
NASHVILLE TN
37211-7048
US

V. Phone/Fax

Practice location:
  • Phone: 615-341-4911
  • Fax:
Mailing address:
  • Phone: 773-547-5590
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number41354
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: