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NPI Code Detail

MEDICARE: JENNIE GRACE GIBBONS

MEDICARE: JENNIE GRACE GIBBONS
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
1171M00000XCase Manager/Care CoordinatorUT

General Provider Information

NPI Number : 1982549242
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNIE GRACE GIBBONS
Provider Business Mailing Address
First Line : 90 E 200 N
Second Line :
City : LOGAN
State : UT
Zip : 84321-4034
Country : US
Telephone Number : 435-752-0750
Fax Number :
Provider Business Practice Location Address
First Line : 90 E 200 N
Second Line :
City : LOGAN
State : UT
Zip : 84321-4034
Country : US
Telephone Number : 435-752-0750
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/22/2026
Last Update Date : 04/22/2026

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Directions to “ JENNIE GRACE GIBBONS ” Practice Location

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