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General NPI Number Information
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NPI Number | 1639820194
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Entity Type | Individual
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Provider Name | LAKISHA GIBSON APRN
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Gender | Female
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Dates
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Enumeration Date | 01/15/2022
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Last Update Date | 11/19/2024
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Provider Practice Location Address
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Address Line | 590 HIGHWAY 18 W
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City | QUITMAN
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State | MS
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Zip | 39355-8739
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Country | US
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Telephone | 601-934-9629
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Fax | 601-429-1314
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Provider Business Mailing Address
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Address Line | 590 HIGHWAY 18 W
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City | QUITMAN
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State | MS
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Zip | 39355-8739
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Country | US
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Telephone | 601-934-9629
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Fax | 601-429-1314
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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 | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | 25D2248675
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License Number State | MS
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 907056
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License Number State | MS
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