Gary Ray Gibson

Key facts

NPI

1154019792

Entity type

Individual (NPI type 1)

Primary specialty

Personal Care Attendant 3747P1801X

Practice address

59 Honaker Rd
Sandstone, WV 25985-9207

Phone

(681) 404-0648

NPI assigned

May 1, 2023

Sex

Male

Sole proprietor

No

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

No

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on May 1, 2023.

{
    "created_epoch": "1682899200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1682899200000",
    "number": "1154019792",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "59 HONAKER RD",
            "city": "SANDSTONE",
            "state": "WV",
            "postal_code": "259859207",
            "telephone_number": "681-404-0648"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "59 HONAKER RD",
            "city": "SANDSTONE",
            "state": "WV",
            "postal_code": "259859207",
            "telephone_number": "681-404-0648"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GIBSON",
        "first_name": "GARY",
        "middle_name": "RAY",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-05-01",
        "last_updated": "2023-05-01",
        "certification_date": "2023-05-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "3747P1801X",
            "taxonomy_group": "",
            "desc": "Technician, Personal Care Attendant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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All providers in Sandstone, WV · Personal Care Attendant in West Virginia