Individual
GRACE ANN GIBSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RD
Contact information
Practice address
97 GREAT TEAYS BLVD STE 6, SCOTT DEPOT, WV 25560-9816
(304) 757-6999
(304) 760-3618
Mailing address
301-6 GREAT TEAYS BLVD, SCOTT DEPOT, WV 25560
(304) 757-6999
(304) 757-3252
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
9
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001998725
MS BCBS
WV
05
—
1346427341
—
WV
05
—
3810010676
—
WV
Enumeration date
01/22/2008
Last updated
08/02/2019
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