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NPI Code Detail

MEDICARE: MRS. MELINDA FAYE GIBSON CRNP

MEDICARE: MRS. MELINDA FAYE GIBSON CRNP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LP0200XPediatric Nurse Practitioner1-069655AL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
151218738OTHERALBCBS ALABAMA
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1104065267
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. MELINDA FAYE GIBSON CRNP
Provider Business Mailing Address
First Line : 46 L V STABLER DR
Second Line :
City : GREENVILLE
State : AL
Zip : 36037-3865
Country : US
Telephone Number : 334-382-9760
Fax Number : 334-383-9331
Provider Business Practice Location Address
First Line : 300 N COLLEGE ST
Second Line :
City : GREENVILLE
State : AL
Zip : 36037-2025
Country : US
Telephone Number : 334-382-2681
Fax Number : 334-383-9884
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/13/2009
Last Update Date : 02/13/2019

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