MEDICARE: JANET GIBSON NP

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	363LF0000X	Family Nurse Practitioner	00170000879	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	P00220177	OTHER	RAILROAD MCR

General Provider Information

NPI Number	:	1154301968
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANET GIBSON NP

Provider Business Mailing Address
First Line	:	8304 BARONS CT
Second Line	:
City	:	WILLIAMSBURG
State	:	VA
Zip	:	23188-6378
Country	:	US
Telephone Number	:	757-634-6240
Fax Number	:

Provider Business Practice Location Address
First Line	:	1600 RICHMOND RD
Second Line	:
City	:	WILLIAMSBURG
State	:	VA
Zip	:	23185-2724
Country	:	US
Telephone Number	:	757-229-0015
Fax Number	:

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

Provider Enumeration Date	:	01/18/2006
Last Update Date	:	06/18/2014

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