Provider Demographics
NPI:1154413243
Name:GIBSON, JEWYL C (FNP)
Entity type:Individual
Prefix:MRS
First Name:JEWYL
Middle Name:C
Last Name:GIBSON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MRS
Other - First Name:JEWYL
Other - Middle Name:C
Other - Last Name:GIBSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:FNP
Mailing Address - Street 1:PO BOX 578
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE WELLS
Mailing Address - State:CO
Mailing Address - Zip Code:80810-0578
Mailing Address - Country:US
Mailing Address - Phone:719-767-5661
Mailing Address - Fax:719-767-5098
Practice Address - Street 1:602 N 6TH ST W
Practice Address - Street 2:
Practice Address - City:CHEYENNE WELLS
Practice Address - State:CO
Practice Address - Zip Code:80810-5125
Practice Address - Country:US
Practice Address - Phone:719-767-5661
Practice Address - Fax:719-767-5098
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN125635363L00000X
COAPN.0002269-C-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner