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General NPI Number Information
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NPI Number | 1225589260
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Entity Type | Individual
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Provider Name | JAMES ELON GIBSON ATC, LAT, LP
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Gender | Male
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Dates
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Enumeration Date | 10/14/2016
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Last Update Date | 12/28/2025
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Provider Practice Location Address
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Address Line | 418 COLLEGE MAIN SUITE 129
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City | COLLEGE STATION
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State | TX
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Zip | 77840-1601
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Country | US
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Telephone | 979-571-8551
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Fax |
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Provider Business Mailing Address
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Address Line | 418 COLLEGE MAIN SUITE 129
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City | COLLEGE STATION
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State | TX
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Zip | 77840-1601
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Country | US
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Telephone | 979-571-8551
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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 | 146L00000X
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Taxonomy Name | Paramedic
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License Number | 94273
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | AT2216
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 020102108
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License Number State | NE
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