Provider Demographics
NPI:1053093096
Name:GIBSON, ASHLEY MAE
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:MAE
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 1:3762 ROUTE 75
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25704-9015
Mailing Address - Country:US
Mailing Address - Phone:681-888-3143
Mailing Address - Fax:
Practice Address - Street 1:3762 ROUTE 75
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25704-9015
Practice Address - Country:US
Practice Address - Phone:681-888-3143
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-01
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant