Mia Gibson, RD,LD,CDE

Primary specialty

Registered DietitianTaxonomy code 133V00000X

License

R663188 Issued in TX

Practice address

8050 E Hwy 191
Odessa, TX 79765-8607

Phone

(432) 640-2128

NPI assigned

Nov 11, 2010

Last updated

Nov 11, 2010By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1289433600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1289433600000",
    "number": "1457652190",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8050 E. HWY 191",
            "city": "ODESSA",
            "state": "TX",
            "postal_code": "79760",
            "telephone_number": "432-640-2128"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8050 E HWY 191",
            "city": "ODESSA",
            "state": "TX",
            "postal_code": "797658607",
            "telephone_number": "432-640-2128"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GIBSON",
        "first_name": "MIA",
        "name_prefix": "Mrs.",
        "credential": "RD,LD,CDE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-11-11",
        "last_updated": "2010-11-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "TX",
            "license": "DT00898",
            "primary": false
        },
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "TX",
            "license": "R663188",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Amaranath Ghanta, M.D.,FCCP,D,ABSM
• Ghassan N. Fanous, M.D. PA
• Ronald Oscar Gibbons, M.D., MBA
• Constance R Gibson, AGACNP
• Jay B Gibson, PA-C
• Beverly Mariel Gifford, FNP
• Vikram Gill, M.D.
• Meghana R Gillala, M.D.
• Tyler Gillham
• Julia Catherine Gilmore, PA-C

• Registered Dietitian in Odessa, TX
• Providers in Odessa, TX by specialty
• Registered Dietitian in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 11, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.