Individual
MIRAL K GIBSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP-C
Contact information
Practice address
402 MEDICAL PARK DR, WESTON, WV 26452-1678
(304) 269-3929
(304) 269-3911
Mailing address
132 CINEMA CIR, BUCKHANNON, WV 26201-0000
(304) 470-0670
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
34016
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3810013138
—
WV
Enumeration date
09/05/2008
Last updated
12/10/2020
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