MEDICARE: KATHRYN MICHELLE 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	367500000X	Certified Registered Nurse Anesthetist	4704345108	MI

General Provider Information

NPI Number	:	1932783636
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHRYN MICHELLE GIBSON

Provider Business Mailing Address
First Line	:	1 FORD PL STE 3A
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48202-3450
Country	:	US
Telephone Number	:	313-874-4806
Fax Number	:

Provider Business Practice Location Address
First Line	:	205 N EAST AVE
Second Line	:
City	:	JACKSON
State	:	MI
Zip	:	49201-1753
Country	:	US
Telephone Number	:	517-205-4946
Fax Number	:

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

Provider Enumeration Date	:	05/08/2021
Last Update Date	:	06/12/2026

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Directions to “ KATHRYN MICHELLE GIBSON ” Practice Location

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