Provider Demographics
NPI:1033917422
Name:GIBBS, RALESIA J (MSED)
Entity type:Individual
Prefix:
First Name:RALESIA
Middle Name:J
Last Name:GIBBS
Suffix:
Gender:
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:272 CALHOUN PKWY STE C2179
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:MS
Mailing Address - Zip Code:39110-6877
Mailing Address - Country:US
Mailing Address - Phone:662-418-1188
Mailing Address - Fax:
Practice Address - Street 1:98 MCGEE RD
Practice Address - Street 2:
Practice Address - City:STARKVILLE
Practice Address - State:MS
Practice Address - Zip Code:39759-4930
Practice Address - Country:US
Practice Address - Phone:662-418-1188
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-03
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist
No172V00000XOther Service ProvidersCommunity Health Worker