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General NPI Number Information
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NPI Number | 1669055802
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Entity Type | Individual
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Provider Name | MEGHAN AUDRA GIBSON CLINE DO
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Gender | Female
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Dates
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Enumeration Date | 05/05/2021
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Last Update Date | 07/08/2025
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Provider Practice Location Address
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Address Line | 9601 BAPTIST HEALTH DR STE 1B
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City | LITTLE ROCK
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State | AR
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Zip | 72205-6321
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Country | US
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Telephone | 501-202-2093
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Fax | 501-202-6316
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Provider Business Mailing Address
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Address Line | 422 BEECHWOOD ST
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City | LITTLE ROCK
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State | AR
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Zip | 72205-3818
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Country | US
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Telephone | 918-440-5529
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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 | 207QH0002X
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Taxonomy Name | Hospice and Palliative Medicine (Family Medicine) Physician
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License Number | E-19392
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License Number State | AR
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | E-19392
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License Number State | AR
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