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General NPI Number Information
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NPI Number | 1225202864
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Entity Type | Individual
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Provider Name | WILLIAM BRYAN GIBBONEY DNP, FNP-C, ACNP-BC
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Gender | Male
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Dates
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Enumeration Date | 04/15/2008
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Last Update Date | 12/23/2019
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Provider Practice Location Address
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Address Line | 1434 CENTRAL AVE E
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City | WIGGINS
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State | MS
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Zip | 39577-9602
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Country | US
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Telephone | 228-436-1191
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Fax |
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Provider Business Mailing Address
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Address Line | 6699 OLD FORT BAYOU RD
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City | OCEAN SPRINGS
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State | MS
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Zip | 39564-7987
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Country | US
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Telephone | 228-872-4349
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Fax |
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | R861831
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License Number State | MS
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Taxonomy #2
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Taxonomy Code | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | R861831
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License Number State | MS
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