MEDICARE: NATHAN 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	101YM0800X	Mental Health Counselor	7822	TN

General Provider Information

NPI Number	:	1386595965
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NATHAN GIBSON

Provider Business Mailing Address
First Line	:	104 BROAD ST STE A
Second Line	:
City	:	ELIZABETHTON
State	:	TN
Zip	:	37643-2762
Country	:	US
Telephone Number	:	423-433-9739
Fax Number	:

Provider Business Practice Location Address
First Line	:	409 E UNAKA AVE
Second Line	:
City	:	JOHNSON CITY
State	:	TN
Zip	:	37601-4030
Country	:	US
Telephone Number	:	423-202-4472
Fax Number	:

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

Provider Enumeration Date	:	02/09/2026
Last Update Date	:	02/09/2026

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