Individual
MRS. LILLIE GIBSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
250 PENDER DR, GRENADA, MS 38901-9312
(662) 226-8900
(662) 226-5767
Mailing address
250 PENDER DR, GRENADA, MS 38901-9312
(662) 226-8900
(662) 226-5767
Taxonomy
Speciality
Code
Description
License number
State
163WS0200X
School Registered Nurse
Primary
R704695
AR
Other
Enumeration date
08/16/2016
Last updated
08/16/2016
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