Organization
GIBBS FAMILY PRACTICE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LESLIE HEISER FNP (SOLE MEMBER)
(865) 249-8044
Entity
Organization
Contact information
Practice address
7331 TAZEWELL PIKE, CORRYTON, TN 37721-3516
(865) 249-8044
Mailing address
7331 TAZEWELL PIKE, CORRYTON, TN 37721-3516
(865) 249-8044
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
APN17718
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1124450648
INDIVIDUAL NPI
TN
01
—
1457726374
GROUP TYPE II NPI
—
05
—
1532504
—
TN
01
—
3706725
MCPTAN
TN
Enumeration date
12/03/2015
Last updated
05/23/2023
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