Healthcare Provider Details

I. General information

NPI: 1467408815
Provider Name (Legal Business Name): WILLIAM THOMAS GIBSON NP, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 03/07/2023
Certification Date: 05/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1125 SE WASHINGTON ST.
PULLMAN WA
99111
US

IV. Provider business mailing address

1125 SE WASHINGTON ST.
PULLMAN WA
99111
US

V. Phone/Fax

Practice location:
  • Phone: 509-335-3575
  • Fax: 509-336-7389
Mailing address:
  • Phone: 509-335-3575
  • Fax: 509-336-7389

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberCNS-11A
License Number StateID
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP30005329
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberAP30005329
License Number StateWA
# 4
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPY12342713
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License NumberPY00002713
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: