| NPI | 1801132980 |
|---|---|
| Former Name | KATIE E GIBBONS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: ID PA-2034) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: TX PA08089) |
| Enumeration Date | 2012-12-18 |
| Last Update Date | 2023-05-15 |