Healthcare Provider Details

I. General information

NPI: 1770797722
Provider Name (Legal Business Name): CLARICE S GIPSON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

338 JOYCE LN
WINCHESTER TN
37398-3326
US

IV. Provider business mailing address

599 MYERS RD
WINCHESTER TN
37398-4584
US

V. Phone/Fax

Practice location:
  • Phone: 931-967-3826
  • Fax: 931-962-1168
Mailing address:
  • Phone: 931-967-2722
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License NumberRN0000027752
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: