Provider Demographics
NPI:1962892489
Name:GIBBS, MAKISHA
Entity type:Individual
Prefix:
First Name:MAKISHA
Middle Name:
Last Name:GIBBS
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 1:4903 SE CHURCHILL WAY
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73501-6405
Mailing Address - Country:US
Mailing Address - Phone:580-228-4647
Mailing Address - Fax:
Practice Address - Street 1:4903 SE CHURCHILL WAY
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73501-6405
Practice Address - Country:US
Practice Address - Phone:580-228-4647
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-04
Last Update Date:2015-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor