1194101485 NPI number — MR. WILLIAM SCOTT GIBSON APRN PMHNP-BC

Table of content: MR. WILLIAM SCOTT GIBSON APRN PMHNP-BC (NPI 1194101485)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194101485 NPI number — MR. WILLIAM SCOTT GIBSON APRN PMHNP-BC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GIBSON
Provider First Name:
WILLIAM
Provider Middle Name:
SCOTT
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
APRN PMHNP-BC
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1194101485
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/30/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
117 CASTLEROCK DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DANVILLE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40422-9462
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
859-209-2198
Provider Business Mailing Address Fax Number:
859-374-5006

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
204 S 2ND ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DANVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40422-1804
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-209-2198
Provider Business Practice Location Address Fax Number:
859-374-5006
Provider Enumeration Date:
08/10/2015

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LP0808X , with the licence number:  3009625 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com