Provider Demographics
NPI:1063721124
Name:GIBSON, JESSYCA LYN (BS)
Entity type:Individual
Prefix:MS
First Name:JESSYCA
Middle Name:LYN
Last Name:GIBSON
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4408 CLEARWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89436-6363
Mailing Address - Country:US
Mailing Address - Phone:775-232-7989
Mailing Address - Fax:775-622-4837
Practice Address - Street 1:4408 CLEARWOOD DR
Practice Address - Street 2:
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89436-6363
Practice Address - Country:US
Practice Address - Phone:775-232-7989
Practice Address - Fax:775-622-4837
Is Sole Proprietor?:No
Enumeration Date:2010-10-06
Last Update Date:2010-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker