MEDICARE: THERESA GIBSON

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
1	163W00000X	Registered Nurse	521692	OH

General Provider Information

NPI Number	:	1134072556
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THERESA GIBSON

Provider Business Mailing Address
First Line	:	3370 SPRINGDALE RD
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45251-1567
Country	:	US
Telephone Number	:	513-302-7152
Fax Number	:

Provider Business Practice Location Address
First Line	:	3370 SPRINGDALE RD
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45251-1567
Country	:	US
Telephone Number	:	513-302-7152
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/16/2026
Last Update Date	:	02/16/2026

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Directions to “ THERESA GIBSON ” Practice Location

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