Individual
MRS. JACQUELINE GAILLARD GIBSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
820 S BOYLAN AVE, RALEIGH, NC 27603-2246
(919) 733-0740
Mailing address
216 WILD HOLLY LN, HOLLY SPRINGS, NC 27540-8654
(919) 557-6040
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
103859
NC
Other
Enumeration date
08/01/2006
Last updated
07/08/2007
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