Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 518287 | TX |
NPI | 1003097155 |
---|---|
Provider Name | Gay Ann Tibbets |
First Address | Lubbock, TX 79453-4136 |
Second Address | Lubbock, TX 79412-2706 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/11/2007 |
Last Update Date | 22/07/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
518287 | RN LICENSE # (01) | TX |