GIBBS FAMILY PRACTICE LLC NPI 1457726374

NPI Information

NPI: 1457726374
Provider Name: GIBBS FAMILY PRACTICE, LLC
Classification: Nurse Practitioner - 363LF0000X
Entity Type: Organization

Specialization: Family

CLIA Number: 44D2105050

Address:
7331 TAZEWELL PIKE
CORRYTON, TN
ZIP 37721
Phone: (865) 249-8044
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GIBBS FAMILY PRACTICE, LLC is a family nurse practitioner in Corryton, TN. GIBBS FAMILY PRACTICE, LLC NPI is 1457726374. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

7331 TAZEWELL PIKE
CORRYTON, TN
ZIP 37721-516
Phone: (865) 249-8044

The provider's authorized official is Leslie Heiser .
The authorized official title is Sole Member and has the following contact phone number (865) 249-8044.

The CLIA number assigned to this NPI record is 44D2105050 - other practitioner with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 12/3/2015 and was last updated on 12/13/2016.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	363LF0000X	Nurse Practitioner	Family	APN17718	TENNESSEE	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	10350I3869	MEDICARE PIN	TENNESSEE
2	1124450648	OTHER	TENNESSEE	INDIVIDUAL NPI
3	3706725	OTHER	TENNESSEE	MCPTAN
4	1457726374	OTHER		GROUP TYPE II NPI
5	1532504	MEDICAID	TENNESSEE
6	103G701321	MEDICARE PIN	TENNESSEE

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

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