Individual
JODI MARIE GIBSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ANP
Contact information
Practice address
1020 HIGHWAY 62 E, MOUNTAIN HOME, AR 72653-3216
(870) 337-2172
Mailing address
PO BOX 306415, NASHVILLE, TN 37230-6415
(931) 253-1110
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
ATP 000216
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
179823758
—
AR
01
—
5V274
MEDICARE PTAN
AR
Enumeration date
06/25/2009
Last updated
05/20/2024
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