Individual
DR. JACQUELYN ELAINE GIBBONS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
145 KIMEL PARK DR STE 120, WINSTON SALEM, NC 27103-6983
(336) 768-3212
(336) 768-9019
Mailing address
145 KIMEL PARK DR STE 120, WINSTON SALEM, NC 27103-6983
(336) 768-3212
(336) 768-9019
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
9901184
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
14151
BCBS
NC
05
—
5905631
—
NC
Enumeration date
07/05/2006
Last updated
03/15/2019
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