Tricha Gibson, LPN

Individual provider Active NPI Licensed Practical Nurse · Columbia, MS

NPI 1780445478 · NPPES record last updated Jan 19, 2024

Key facts

NPI
1780445478
Entity type
Individual (NPI type 1)
Primary specialty
Licensed Practical Nurse 164W00000X
License
339468 (MS)
Practice address
1448 N Main St
Columbia, MS 39429-2068
Phone
(601) 736-8143
NPI assigned
Jan 19, 2024
Sex
Female
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

State licenses

LicenseStateTypeSpecialty
339468MSMDLicensed Practical Nurse

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Licensed Practical Nurse 164W00000X 339468 MS Yes

Addresses

Primary practice location

1448 N Main St
Columbia, MS 39429-2068

Mailing address

PO Box 18679
Hattiesburg, MS 39404-8679
Phone (601) 705-1901

Other providers in Columbia, MS

All providers in Columbia, MS · Licensed Practical Nurse in Mississippi

Sources for this page

Verify at the official NPI Registry.