Provider Demographics
NPI:1386891950
Name:GIBNEY, JESSICA ANN (MD)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:ANN
Last Name:GIBNEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:457 19TH AVE CIRCLE NW
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28601
Mailing Address - Country:US
Mailing Address - Phone:434-385-7818
Mailing Address - Fax:828-345-0350
Practice Address - Street 1:457 19TH AVENUE NW
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28601
Practice Address - Country:US
Practice Address - Phone:434-385-7818
Practice Address - Fax:828-345-0350
Is Sole Proprietor?:No
Enumeration Date:2008-08-26
Last Update Date:2016-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC201501870207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1386891950Medicaid
VA1386891950Medicaid