Provider Demographics
NPI:1154481463
Name:GIBSON, TERI TAYLOR (CRNA)
Entity type:Individual
Prefix:
First Name:TERI
Middle Name:TAYLOR
Last Name:GIBSON
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:TERI
Other - Middle Name:L
Other - Last Name:TAYLOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:PO BOX 2930
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46206-2930
Mailing Address - Country:US
Mailing Address - Phone:423-892-5602
Mailing Address - Fax:855-630-1300
Practice Address - Street 1:975 E. THIRD ST
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37403-2147
Practice Address - Country:US
Practice Address - Phone:423-778-7608
Practice Address - Fax:423-778-2360
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2022-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN110128163W00000X
TNAPN10091367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3164049OtherBLUE CROSS BLUE SHIELD TN
GA000901029AMedicaid
TN430064690OtherRAILROAD MEDICARE
AL009947280Medicaid
TN3631375Medicaid
NC8052091Medicaid
TN3631370Medicare PIN