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Stephanie Renae Gibson

Nurse Practitioner

Physician Assistants & Advanced Practice Nursing Providers

PECOS Enrollment

This provider is enrolled in PECOS as STEPHANIE GIBSON.

Based on the most recent information from CMS, provider Stephanie Renae Gibson is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records yesterday at 11:47 AM.

Profile Details

Provider ID
1235845298
Provider Type
Individual
Full Name
Gibson, Stephanie Renae
Title
Ms.
Credential
APN

Gender
Female
Sole Proprietor
No
Enumeration Date
1/24/2023
Last Updated
1/24/2023

Contact Information

Practice Location

6012 Main St, Voorhees, NJ 08043-4659

(856) 325-6622

Unlisted Fax

Mailing Location

6012 Main St, Voorhees, NJ 08043-4659

(856) 325-6622

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 363LF0000X Primary	Description Nurse Practitioner Physician Assistants & Advanced Practice Nursing Providers	License 26NR17445700 New Jersey

Stephanie Renae Gibson

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

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