Provider Demographics
NPI:1649142001
Name:GIBSON, SAMANTHA (FNP-BC, APRN)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:GIBSON
Suffix:
Gender:F
Credentials:FNP-BC, APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1901 N HEMMER RD APT 208
Mailing Address - Street 2:
Mailing Address - City:PALMER
Mailing Address - State:AK
Mailing Address - Zip Code:99645-9673
Mailing Address - Country:US
Mailing Address - Phone:907-203-4677
Mailing Address - Fax:800-516-0397
Practice Address - Street 1:1901 N HEMMER RD APT 208
Practice Address - Street 2:
Practice Address - City:PALMER
Practice Address - State:AK
Practice Address - Zip Code:99645-9673
Practice Address - Country:US
Practice Address - Phone:907-203-4677
Practice Address - Fax:800-516-0397
Is Sole Proprietor?:No
Enumeration Date:2025-09-23
Last Update Date:2025-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK245048207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine