MEDICARE: LATOYA D 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	363LA2200X	Adult Health Nurse Practitioner	24285	SC
2	363LG0600X	Gerontology Nurse Practitioner	24285	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1841898038
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LATOYA D GIBSON

Provider Business Mailing Address
First Line	:	300 E MCBEE AVE FL 4
Second Line	:
City	:	GREENVILLE
State	:	SC
Zip	:	29601-2842
Country	:	US
Telephone Number	:	864-522-8603
Fax Number	:

Provider Business Practice Location Address
First Line	:	701 GROVE RD
Second Line	:
City	:	GREENVILLE
State	:	SC
Zip	:	29605-4210
Country	:	US
Telephone Number	:	864-455-2455
Fax Number	:	864-455-2450

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

Provider Enumeration Date	:	10/12/2020
Last Update Date	:	12/03/2025

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Directions to “ LATOYA D GIBSON ” Practice Location

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