Healthcare Provider Details

I. General information

NPI: 1396754495
Provider Name (Legal Business Name): PAULA KAYE GIBBS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: PAULA KAYE GIBBS-TAYLOR M.D.

II. Dates (important events)

Enumeration Date: 08/07/2006
Last Update Date: 11/01/2021
Certification Date: 11/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 CHIPETA WAY SUITE # 1123
SALT LAKE CITY UT
84108-1222
US

IV. Provider business mailing address

501 CHIPETA WAY SUITE # 1123
SALT LAKE CITY UT
84108-1222
US

V. Phone/Fax

Practice location:
  • Phone: 801-585-1575
  • Fax: 801-585-5545
Mailing address:
  • Phone: 801-585-1575
  • Fax: 801-585-5545

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number172419-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: