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General NPI Number Information
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NPI Number | 1669012423
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Entity Type | Individual
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Provider Name | TIFFANY KATHLEEN GIBBS
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Gender | Female
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Dates
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Enumeration Date | 01/09/2020
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Last Update Date | 01/09/2020
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Provider Practice Location Address
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Address Line | 2492 S CITIES SERVICE HWY STE 1
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City | SULPHUR
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State | LA
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Zip | 70665-6497
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Country | US
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Telephone | 337-905-1962
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Fax |
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Provider Business Mailing Address
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Address Line | 6655 LYNN RD
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City | BELL CITY
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State | LA
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Zip | 70630-4015
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Country | US
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Telephone | 337-396-2539
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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 | AP10186
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License Number State | LA
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