=====================================================
General NPI Number Information
=====================================================
NPI Number | 1558289314
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | COURTNEY ANNE COX GIBSON FNP-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/08/2026
-----------------------------------------------------
Last Update Date | 07/08/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6410 W HAMILTON PARK DR
-----------------------------------------------------
City | COLUMBUS
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 31909-3004
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 706-329-7645
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 589 SPRING LAKE DR
-----------------------------------------------------
City | FORTSON
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 31808-5344
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 843-260-0630
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | APRN-NP263401
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------