MEDICARE: DR. AMBER NICOLE 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	103TC0700X	Clinical Psychologist	71504	TX

General Provider Information

NPI Number	:	1427754977
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AMBER NICOLE GIBSON

Provider Business Mailing Address
First Line	:	5323 HARRY HINES BLVD
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75390-7201
Country	:	US
Telephone Number	:	972-415-5628
Fax Number	:

Provider Business Practice Location Address
First Line	:	1341 W MOCKINGBIRD LN
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75247-6913
Country	:	US
Telephone Number	:	214-456-7700
Fax Number	:

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

Provider Enumeration Date	:	02/06/2023
Last Update Date	:	01/15/2026

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