Individual
TIJUANA NICHOLE GIBSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
1589 KESSELRING RD, MUNFORDVILLE, KY 42765-9565
(270) 331-3009
Mailing address
845 S 3RD ST, LOUISVILLE, KY 40203-2213
(502) 585-9911
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
1140290
KY
Other
Enumeration date
07/31/2024
Last updated
07/31/2024
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