Provider Demographics
NPI:1861060469
Name:GIPSON, EMILY (MD)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:GIPSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:
Other - Last Name:OVERMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:4755 PASTURE ROAD BLDG 299
Mailing Address - Street 2:NAVAL AIR STATION FALLON
Mailing Address - City:FALLON
Mailing Address - State:NV
Mailing Address - Zip Code:89496
Mailing Address - Country:US
Mailing Address - Phone:775-426-3125
Mailing Address - Fax:
Practice Address - Street 1:4755 PASTURE ROAD BLDG 299
Practice Address - Street 2:NAVAL AIR STATION FALLON
Practice Address - City:FALLON
Practice Address - State:NV
Practice Address - Zip Code:89496
Practice Address - Country:US
Practice Address - Phone:775-426-3125
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-11
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171000000X, 390200000X
AL44898208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No171000000XOther Service ProvidersMilitary Health Care Provider
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program