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General NPI Number Information
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NPI Number | 1265976765
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Entity Type | Individual
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Provider Name | DILLON TYLER GIBSON PA
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Gender | Male
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Dates
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Enumeration Date | 12/19/2016
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Last Update Date | 08/29/2023
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Provider Practice Location Address
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Address Line | HEALTHSTAR PHYSICIANS 420 W. MORRIS BLVD SUITE 400D
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City | MORRISTOWN
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State | TN
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Zip | 37813
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Country | US
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Telephone | 423-586-7509
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Fax |
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Provider Business Mailing Address
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Address Line | 420 W MORRIS BLVD STE 400D
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City | MORRISTOWN
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State | TN
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Zip | 37813-2282
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Country | US
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Telephone | 423-586-7509
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Fax | 423-317-8948
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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 | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 3169
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 3169
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License Number State | TN
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