Provider Demographics
NPI:1548973993
Name:GIPSON, STEVON (CEO)
Entity type:Individual
Prefix:
First Name:STEVON
Middle Name:
Last Name:GIPSON
Suffix:
Gender:M
Credentials:CEO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6160 WARREN PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-9415
Mailing Address - Country:US
Mailing Address - Phone:469-200-0650
Mailing Address - Fax:
Practice Address - Street 1:6160 WARREN PKWY STE 100
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-9415
Practice Address - Country:US
Practice Address - Phone:469-200-0650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-30
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide