Individual
ANGELA GOODWIN GIBSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APMH-NP BC
Contact information
Practice address
1500 E., WOODROW WILSON DR, JACKSON VA MEDICAL CENTER, JACKSON, MS 39216
(601) 362-4471
Mailing address
2250 5TH STREET NORTH, BAPTIST MEMORIAL HOSPITAL GOLDEN TRIANGLE, COLUMBUS, MS 39701
(662) 244-1000
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
R623334
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03108385
—
MS
Enumeration date
08/12/2006
Last updated
07/02/2014
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