Provider Demographics
NPI:1396754495
Name:GIBBS, PAULA KAYE (MD)
Entity type:Individual
Prefix:DR
First Name:PAULA
Middle Name:KAYE
Last Name:GIBBS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:PAULA
Other - Middle Name:KAYE
Other - Last Name:GIBBS-TAYLOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:501 CHIPETA WAY
Mailing Address - Street 2:SUITE # 1123
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84108-1222
Mailing Address - Country:US
Mailing Address - Phone:801-585-1575
Mailing Address - Fax:801-585-5545
Practice Address - Street 1:501 CHIPETA WAY
Practice Address - Street 2:SUITE # 1123
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84108-1222
Practice Address - Country:US
Practice Address - Phone:801-585-1575
Practice Address - Fax:801-585-5545
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2021-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT172419-12052084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTE00019Medicare UPIN