Provider Demographics
NPI:1588969463
Name:GIBSON, KIMBERLY BROOKE (FNP)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:BROOKE
Last Name:GIBSON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MISS
Other - First Name:KIMBERLY
Other - Middle Name:BROOKE
Other - Last Name:NAPIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:999 EXECUTIVE PARK BLVD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37660-4632
Mailing Address - Country:US
Mailing Address - Phone:423-224-3250
Mailing Address - Fax:423-224-3258
Practice Address - Street 1:111 W STONE DR
Practice Address - Street 2:SUITE 110
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-6027
Practice Address - Country:US
Practice Address - Phone:423-723-2030
Practice Address - Fax:423-247-4110
Is Sole Proprietor?:No
Enumeration Date:2011-01-24
Last Update Date:2012-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN15668363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN10350I0273Medicare PIN