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NPI Code Detail

MEDICARE: BENJAMIN RANDALL GIBSON PMHNP

MEDICARE: BENJAMIN RANDALL GIBSON PMHNP
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
1363LP0808XPsychiatric/Mental Health Nurse PractitionerAPRN11035935FL

General Provider Information

NPI Number : 1871315747
Entity Type Code : Individual
Provider Name (Legal Business Name) : BENJAMIN RANDALL GIBSON PMHNP
Provider Business Mailing Address
First Line : 1221 W LAKEVIEW AVE
Second Line :
City : PENSACOLA
State : FL
Zip : 32501-1836
Country : US
Telephone Number : 850-469-3500
Fax Number : 850-595-1400
Provider Business Practice Location Address
First Line : 1221 W LAKEVIEW AVE
Second Line :
City : PENSACOLA
State : FL
Zip : 32501-1836
Country : US
Telephone Number : 850-469-3500
Fax Number : 850-595-1400
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/30/2024
Last Update Date : 03/12/2026

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