Active NPI
Michael Gibson
- Licensed Practical Nurse
- Plymouth Meeting, PA
National Provider Identifier
1215452438
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Licensed Practical Nurse
- License
- PN272110
- Practice address
- 2250 Hickory Rd Ste 240
Plymouth Meeting, PA 19462-2225 - Phone
- (610) 834-1122
- NPI assigned
- Aug 9, 2017
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Licensed Practical Nurse | 164W00000X | PN272110 | PA | Primary |
Addresses
Primary practice location
2250 Hickory Rd Ste 240
Plymouth Meeting, PA 19462-2225
Mailing address
108 Fairview Ave
Bala Cynwyd, PA 19004-1809
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| PN272110 | Other | PA | PA LPN LICENCE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PN272110 | PA | MD | Licensed Practical Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1502236800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1502236800000",
"number": "1215452438",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "108 FAIRVIEW AVE",
"city": "BALA CYNWYD",
"state": "PA",
"postal_code": "190041809"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2250 HICKORY RD STE 240",
"city": "PLYMOUTH MEETING",
"state": "PA",
"postal_code": "194622225",
"telephone_number": "610-834-1122"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GIBSON",
"first_name": "MICHAEL",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2017-08-09",
"last_updated": "2017-08-09",
"status": "A"
},
"taxonomies": [
{
"code": "164W00000X",
"taxonomy_group": "",
"desc": "Licensed Practical Nurse",
"state": "PA",
"license": "PN272110",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PA LPN LICENCE",
"identifier": "PN272110",
"state": "PA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Plymouth Meeting, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 9, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.