Individual
MICKEY GIBSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
126 PLANTATION TRCE, BOSSIER CITY, LA 71112-8806
(318) 245-1120
Mailing address
126 PLANTATION TRCE, BOSSIER CITY, LA 71112-8806
Taxonomy
Speciality
Code
Description
License number
State
376J00000X
Homemaker
Primary
—
—
Other
Enumeration date
04/04/2023
Last updated
04/04/2023
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