Provider Demographics
NPI:1053026500
Name:GIBSON, JERI MELINDA
Entity type:Individual
Prefix:
First Name:JERI
Middle Name:MELINDA
Last Name:GIBSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 13TH ST APT 5
Mailing Address - Street 2:
Mailing Address - City:PARKERSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26101-4454
Mailing Address - Country:US
Mailing Address - Phone:681-588-3056
Mailing Address - Fax:
Practice Address - Street 1:650 13TH ST APT 5
Practice Address - Street 2:
Practice Address - City:PARKERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26101-4454
Practice Address - Country:US
Practice Address - Phone:681-588-3056
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-19
Last Update Date:2023-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant