Provider Demographics
NPI:1063226074
Name:GIBSON, TYSON JAY (PA-C)
Entity type:Individual
Prefix:
First Name:TYSON
Middle Name:JAY
Last Name:GIBSON
Suffix:
Gender:M
Credentials:PA-C
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Mailing Address - Street 1:2101 HIGHWAY 90
Mailing Address - Street 2:
Mailing Address - City:GAUTIER
Mailing Address - State:MS
Mailing Address - Zip Code:39553-5340
Mailing Address - Country:US
Mailing Address - Phone:228-497-7576
Mailing Address - Fax:228-497-8869
Practice Address - Street 1:3535 BIENVILLE BLVD
Practice Address - Street 2:
Practice Address - City:OCEAN SPRINGS
Practice Address - State:MS
Practice Address - Zip Code:39564-5705
Practice Address - Country:US
Practice Address - Phone:228-872-1641
Practice Address - Fax:228-818-4178
Is Sole Proprietor?:No
Enumeration Date:2025-02-03
Last Update Date:2025-11-13
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Provider Licenses
StateLicense IDTaxonomies
MSPA00872363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical