Individual
MRS. ALYCIA D GIBSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PAC
Contact information
Practice address
239 TYSON AVE, PARIS, TN 38242-4544
(731) 644-8208
(731) 644-8551
Mailing address
4407 HIGHWAY 140 S, MC KENZIE, TN 38201-5121
(731) 243-4826
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
0000001274
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1515861
—
TN
01
—
44D2000904
CLIA
TN
Enumeration date
07/05/2006
Last updated
08/25/2022
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