Individual
SIMON JACK GIBSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DNP, CRNA
Contact information
Practice address
8915 POTOMAC DR, CHATTANOOGA, TN 37421-2008
(601) 826-9031
Mailing address
410 N CEDAR BLUFF RD, STE 300, KNOXVILLE, TN 37923-3632
(865) 342-8900
(865) 691-0843
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
877434
MS
367500000X
Certified Registered Nurse Anesthetist
Primary
GAA-CRNA000891
GA
Other
Enumeration date
01/16/2017
Last updated
08/16/2022
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