Healthcare Provider Details

I. General information

NPI: 1316309560
Provider Name (Legal Business Name): ASHLEY RENEE GIBSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2016
Last Update Date: 03/23/2026
Certification Date: 03/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6410 FANNIN ST STE 1425
HOUSTON TX
77030-5305
US

IV. Provider business mailing address

6410 FANNIN ST STE 1425
HOUSTON TX
77030-5305
US

V. Phone/Fax

Practice location:
  • Phone: 713-500-7840
  • Fax: 713-500-0711
Mailing address:
  • Phone: 713-500-7840
  • Fax: 713-500-0711

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberS1104
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code2080C0008X
TaxonomyChild Abuse Pediatrics Physician
License NumberS1104
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: