Gibson, Tracy

Gibson, Tracy is an individual health care provider with primary practice located at 500 S 11Th Ave Suite 402, Pocatello ID 83201-4835. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Advanced Practice Midwife, which is considered as her primary health care specialty. Gibson, Tracy can be contacted via phone (208) 239-3412.

Contact Information

Primary practice address
500 S 11Th Ave Suite 402 Pocatello ID 83201-4835
Phone: (208) 239-3412
Fax: (208) 239-3441
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Advanced Practice Midwife 367A00000X CNM33 Idaho

Profile Details

NPI number 1700896685
LBN Legal business name Gibson, Tracy
Credentials Certified Nurse Midwife (CNM)
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 9th, 2006
Last updated Mar 3rd, 2011 - about 14 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1700896685 NPPES
Idaho MEDICAID 805053800
Idaho Other NPYT9
Idaho Other P00175232
Idaho Other 000010146389

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