Individual
KRESTON TYRELL GIBBS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1122 N PINE ST, FORDYCE, AR 71742-7009
(870) 807-3639
Mailing address
1122 N PINE ST, FORDYCE, AR 71742-7009
(870) 807-3639
Taxonomy
Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
Primary
—
AR
Other
Enumeration date
10/10/2022
Last updated
04/24/2023
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