Individual
MRS. MIA GIBSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RD,LD,CDE
Contact information
Practice address
8050 E HWY 191, ODESSA, TX 79765-8607
(432) 640-2128
Mailing address
8050 E. HWY 191, ODESSA, TX 79760
(432) 640-2128
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
DT00898
TX
133V00000X
Registered Dietitian
Primary
R663188
TX
Other
Enumeration date
11/11/2010
Last updated
11/11/2010
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