Individual
CAROL LACY GIBSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
1452 CHAIN BRIDGE RD, MCLEAN, VA 22101
(571) 239-2765
Mailing address
1452 CHAIN BRIDGE RD, MC LEAN, VA 22101-3706
(571) 239-2765
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
0024164967
VA
363LF0000X
Family Nurse Practitioner
R154036
MD
363LF0000X
Family Nurse Practitioner
RN62762
DC
Other
Enumeration date
08/19/2011
Last updated
09/09/2016
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