Individual
JACQUELINE B. GIBBONS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.
Contact information
Practice address
ONE PAGE ROAD, PINEHURST, NC 28374
(910) 295-6868
(910) 295-1514
Mailing address
PO BOX 1749, PINEHURST, NC 28370-1749
(910) 295-6868
(910) 295-1514
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
8092
NC
363AS0400X
Surgical Physician Assistant
Primary
0010-01257
NC
363AS0400X
Surgical Physician Assistant
772
SC
Other
Enumeration date
11/07/2006
Last updated
07/26/2010
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