Provider Demographics
NPI:1588296032
Name:GIBSON, LAURA KAY
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:KAY
Last Name:GIBSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5773 AMBERBROOKE ARCH APT 302
Mailing Address - Street 2:
Mailing Address - City:VA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23464-9121
Mailing Address - Country:US
Mailing Address - Phone:540-968-3073
Mailing Address - Fax:
Practice Address - Street 1:5900 E VA BEACH BLVD STE 260
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23502-2492
Practice Address - Country:US
Practice Address - Phone:757-252-7800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-12
Last Update Date:2020-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024178797363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily