Individual
JONATHAN GIPSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2603 KENTUCKY AVE, SUITE 404, PADUCAH, KY 42003-3814
(270) 443-6472
(270) 442-1649
Mailing address
2605 KENTUCKY AVE, SUITE 306, PADUCAH, KY 42003-3800
(270) 415-7653
(270) 575-8359
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
3008526
KY
363LF0000X
Family Nurse Practitioner
Primary
3008526
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100286630
—
KY
Enumeration date
02/20/2014
Last updated
12/02/2020
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