MEDICARE: DR. PATRICIA LYNNE GIBSON M.D.

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	2084P0800X	Psychiatry Physician	E-6241	AR

General Provider Information

NPI Number	:	1871696575
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PATRICIA LYNNE GIBSON M.D.

Provider Business Mailing Address
First Line	:	25 BASS DR
Second Line	:
City	:	LITTLE ROCK
State	:	AR
Zip	:	72223-4693
Country	:	US
Telephone Number	:	501-615-5935
Fax Number	:

Provider Business Practice Location Address
First Line	:	11001 EXECUTIVE CENTER DR
Second Line	:	SUITE 200
City	:	LITTLE ROCK
State	:	AR
Zip	:	72211-4316
Country	:	US
Telephone Number	:	501-615-5935
Fax Number	:

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

Provider Enumeration Date	:	09/07/2006
Last Update Date	:	02/08/2017

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