Individual
BRIAN CLAYTON GIBSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CNP
Contact information
Practice address
415 S 28TH AVE, HATTIESBURG, MS 39401-7246
(601) 268-5800
(601) 261-3530
Mailing address
415 S 28TH AVE, HATTIESBURG, MS 39401-7246
(601) 579-5463
(601) 579-5240
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
R872628
MS
363LF0000X
Family Nurse Practitioner
R872628
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
09853301
—
MS
01
—
9695764
AETNA
MS
01
—
P01013953
RAILROAD MEDICARE
MS
Enumeration date
08/04/2011
Last updated
01/30/2015
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