Provider Demographics
NPI:1902273808
Name:ALSTON-GIBSON, TAMIEKA LATRELL (FNP)
Entity Type:Individual
Prefix:MRS
First Name:TAMIEKA
Middle Name:LATRELL
Last Name:ALSTON-GIBSON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:169 HALL ST
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29302-1523
Mailing Address - Country:US
Mailing Address - Phone:864-358-9278
Mailing Address - Fax:864-751-5352
Practice Address - Street 1:169 HALL ST
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29302-1523
Practice Address - Country:US
Practice Address - Phone:864-358-9278
Practice Address - Fax:564-308-1167
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-26
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC19703363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP3545Medicaid