Healthcare Provider Details

I. General information

NPI: 1154240950
Provider Name (Legal Business Name): BELISHA GIBSON PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2026
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5401 LEBANON RD
FRISCO TX
75034-5150
US

IV. Provider business mailing address

5401 LEBANON RD
FRISCO TX
75034-5150
US

V. Phone/Fax

Practice location:
  • Phone: 972-624-8170
  • Fax: 972-624-8204
Mailing address:
  • Phone: 972-624-8170
  • Fax: 972-624-8204

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA20454
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: