Individual
MYKENZI GIBBS
Active
Individual
MYKENZI GIBBS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
8248-23
WI
363AM0700X
Medical Physician Assistant
Primary
2021
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1053733394
—
WI
05
—
2089PA
—
SC
Enumeration date
01/06/2014
Last updated
02/04/2025
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