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General NPI Number Information
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NPI Number | 1871696575
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Entity Type | Individual
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Provider Name | PATRICIA LYNNE GIBSON M.D.
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Gender | Female
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Dates
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Enumeration Date | 09/07/2006
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Last Update Date | 02/08/2017
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Provider Practice Location Address
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Address Line | 11001 EXECUTIVE CENTER DR SUITE 200
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City | LITTLE ROCK
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State | AR
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Zip | 72211-4316
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Country | US
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Telephone | 501-615-5935
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Fax |
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Provider Business Mailing Address
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Address Line | 25 BASS DR
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City | LITTLE ROCK
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State | AR
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Zip | 72223-4693
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Country | US
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Telephone | 501-615-5935
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | E-6241
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License Number State | AR
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