Provider Demographics
NPI:1194766295
Name:GIBSON, ANNA MARIE (CFNP)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:MARIE
Last Name:GIBSON
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:ANNA
Other - Middle Name:MARIE
Other - Last Name:PERRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7718 COUNTY ROAD 107
Mailing Address - Street 2:
Mailing Address - City:PROCTORVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45669-7928
Mailing Address - Country:US
Mailing Address - Phone:740-886-1150
Mailing Address - Fax:740-886-1177
Practice Address - Street 1:7718 COUNTY ROAD 107
Practice Address - Street 2:
Practice Address - City:PROCTORVILLE
Practice Address - State:OH
Practice Address - Zip Code:45669-7928
Practice Address - Country:US
Practice Address - Phone:740-886-1150
Practice Address - Fax:740-886-1177
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV54213363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV7102183000Medicaid
WVP00174864OtherRAILROAD MEDICARE
OH2561286Medicaid
WVP00174864OtherRAILROAD MEDICARE
OH2561286Medicaid