Provider Demographics
NPI:1679315139
Name:GIBSON, PAIGE KATHERINE (PA-C)
Entity type:Individual
Prefix:
First Name:PAIGE
Middle Name:KATHERINE
Last Name:GIBSON
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:572 BEACON LAKE DR APT 5
Mailing Address - Street 2:
Mailing Address - City:MASON
Mailing Address - State:MI
Mailing Address - Zip Code:48854-2901
Mailing Address - Country:US
Mailing Address - Phone:517-672-0650
Mailing Address - Fax:
Practice Address - Street 1:2195 SPRING ARBOR RD
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49203-2878
Practice Address - Country:US
Practice Address - Phone:517-539-6111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-06
Last Update Date:2025-02-19
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant