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General NPI Number Information
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NPI Number | 1174578835
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Entity Type | Individual
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Provider Name | CRYSTAL D GIBSON PA C
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Gender | Female
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Dates
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Enumeration Date | 05/23/2006
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Last Update Date | 11/15/2024
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Provider Practice Location Address
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Address Line | 101 TOWN AND COUNTRY LN SUITE 100
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City | HAZARD
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State | KY
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Zip | 41701-9524
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Country | US
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Telephone | 606-439-1300
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Fax | 606-439-1400
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Provider Business Mailing Address
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Address Line | 200 MEDICAL CENTER DR STE 1A
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City | HAZARD
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State | KY
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Zip | 41701-9477
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Country | US
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Telephone | 606-439-5220
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Fax | 606-439-5221
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA807
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License Number State | KY
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