Provider Demographics
NPI:1902249279
Name:GIBSON, STACY ELAINE (MD)
Entity Type:Individual
Prefix:MS
First Name:STACY
Middle Name:ELAINE
Last Name:GIBSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1001 N MISSOURI AVE
Mailing Address - Street 2:PO BOX 83
Mailing Address - City:CORNING
Mailing Address - State:AR
Mailing Address - Zip Code:72422
Mailing Address - Country:US
Mailing Address - Phone:870-857-3334
Mailing Address - Fax:870-857-9934
Practice Address - Street 1:201 COLONIAL DR
Practice Address - Street 2:
Practice Address - City:WALNUT RIDGE
Practice Address - State:AR
Practice Address - Zip Code:72476-1410
Practice Address - Country:US
Practice Address - Phone:870-886-5632
Practice Address - Fax:870-886-5632
Is Sole Proprietor?:No
Enumeration Date:2013-04-16
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ARE-9548207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine