Individual
JESSICA R GIBBONS
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
RD
Contact information
Practice address
1380 E MEDICAL CENTER DR, ST GEORGE, UT 84790-2123
(435) 251-1000
(435) 688-5514
Mailing address
PO BOX 30180, SALT LAKE CITY, UT 84130-0180
(435) 251-1000
(435) 688-5514
Taxonomy
Speciality
Code
Description
License number
State
163WD0400X
Diabetes Educator Registered Nurse
Primary
3723144901
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
844515
—
AZ
05
—
D3424
—
UT
Enumeration date
09/30/2005
Last updated
07/08/2007
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