Individual
HALEY GIBBS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1549 E 70TH ST STE 300, SHREVEPORT, LA 71105-5056
(318) 300-3898
(318) 797-4241
Mailing address
8731 PARK PLAZA DR, SHREVEPORT, LA 71105-5682
(318) 524-7144
(318) 797-5844
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
333903
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
15744134
CAQH
—
Enumeration date
08/29/2022
Last updated
10/04/2024
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