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General NPI Number Information
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NPI Number | 1194223891
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Entity Type | Individual
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Provider Name | MELISSA ANN GIBBS APRN
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Gender | Female
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Dates
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Enumeration Date | 01/28/2018
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Last Update Date | 03/18/2025
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Provider Practice Location Address
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Address Line | 3637 E JOHNSON AVE STE B
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City | JONESBORO
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State | AR
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Zip | 72405-1808
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Country | US
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Telephone | 877-522-1275
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Fax | 509-491-3031
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Provider Business Mailing Address
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Address Line | 500 SW 7TH ST STE A205
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City | RENTON
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State | WA
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Zip | 98057-2983
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Country | US
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Telephone | 509-222-1275
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Fax | 509-491-3031
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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 | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | A005468
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License Number State | AR
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | A005468
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License Number State | AR
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