Individual
KERMIT DONALD GIBSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
165 E MAIN ST, ELKHORN CITY, KY 41522-9043
(606) 754-4158
(606) 754-5452
Mailing address
165 E MAIN ST, ELKHORN CITY, KY 41522-9043
(606) 754-4158
(606) 754-5452
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
02080
KY
208D00000X
General Practice Physician
Primary
02080
KY
261QP2300X
Primary Care Clinic/Center
02080
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
112617
FED BLACK LUNG
—
01
—
1270152
UMWA FUNDS
—
05
—
64020803
—
KY
Enumeration date
01/26/2007
Last updated
10/31/2025
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