Jacqueline Gaillard Gibson, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

103859 Issued in NC

Practice address

820 S Boylan Ave
Raleigh, NC 27603-2246

Phone

(919) 733-0740

NPI assigned

Aug 1, 2006

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NC

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2003

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

County of WakeGroup PAC ID 6305759952, 21 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• County of Wake

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Raleigh, NC
  • NPI 1295761617
  Medicare reassignment Care Compare group NPD
• County of Wake

  • State or Local Public Health Clinic/Center
  • Raleigh, NC
  • NPI 1801957576
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1154390400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1093721714",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "216 WILD HOLLY LN",
            "city": "HOLLY SPRINGS",
            "state": "NC",
            "postal_code": "275408654",
            "telephone_number": "919-557-6040"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "820 S BOYLAN AVE",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276032246",
            "telephone_number": "919-733-0740"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GIBSON",
        "first_name": "JACQUELINE",
        "middle_name": "GAILLARD",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-01",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NC",
            "license": "103859",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Asya Gibson
• Cindy Gibson, CCC-SLP
• Colin Desmond Gibson, M.D.
• Debra Luanne Gibson, M.D.
• Elaine S Gibson, LCSW
• Jazlin Gibson, PT, DPT
• Jean Pennington Gibson, LCSW
• Latisha Michelle Gibson, MS,LCAS-A
• Mary Sybil Gibson, CRNA
• Meredith Prescott Gibson, M.A., CCC-SLP

• Medical Physician Assistant in Raleigh, NC
• Providers in Raleigh, NC by specialty
• Medical Physician Assistant in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.