Individual
MR. KENNEDY LEE GIBBS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MEDICAL STUDENT MD
Contact information
Practice address
2 PROFESSIONAL PARK DR STE 21, JOHNSON CITY, TN 37604-6584
(423) 379-8082
(423) 379-8154
Mailing address
2 PROFESSIONAL PARK DR STE 21, JOHNSON CITY, TN 37604-6584
(423) 379-8082
(423) 379-8154
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
07/11/2024
Last updated
03/26/2026
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