Individual
STACEE MARIE GIBSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ATC
Contact information
Practice address
400 E COLLEGE ST, GEORGETOWN, KY 40324-1628
(859) 274-2128
Mailing address
4146 WINNEPEG CT, LEXINGTON, KY 40515-5705
(859) 274-2128
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
TCA518
KY
Other
Enumeration date
05/31/2017
Last updated
05/31/2017
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