Healthcare Provider Details

I. General information

NPI: 1306726864
Provider Name (Legal Business Name): RICHARD ASHLEY GIBBS RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2025
Last Update Date: 09/05/2025
Certification Date: 09/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4605 MACCORKLE AVE SW
SOUTH CHARLESTON WV
25309-1311
US

IV. Provider business mailing address

110 CATHERINE DR REAR
HURRICANE WV
25526-1508
US

V. Phone/Fax

Practice location:
  • Phone: 307-766-3600
  • Fax:
Mailing address:
  • Phone: 307-766-3600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number122426
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: