Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | RN226432 | GA |
N | 363LC0200X | Nurse Practitioner - Critical Care Medicine | RN226432 | GA |
N | 363LG0600X | Nurse Practitioner - Gerontology | RN226432 | GA |
NPI | 1073047478 |
---|---|
Provider Name | Mr. Kyle Steven Gibson |
First Address | Atlanta, GA 30374-2616 |
Second Address | Gainesville, GA 30501-3715 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/04/2017 |
Last Update Date | 05/05/2017 |