Provider Demographics
NPI:1760293328
Name:GIBSON, CALEB TODD (NRP)
Entity type:Individual
Prefix:
First Name:CALEB
Middle Name:TODD
Last Name:GIBSON
Suffix:
Gender:M
Credentials:NRP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4209 FARM RD
Mailing Address - Street 2:
Mailing Address - City:MOORE
Mailing Address - State:OK
Mailing Address - Zip Code:73160-7660
Mailing Address - Country:US
Mailing Address - Phone:405-503-8795
Mailing Address - Fax:
Practice Address - Street 1:4102 PINION DR UNIT 100
Practice Address - Street 2:
Practice Address - City:USAF ACADEMY
Practice Address - State:CO
Practice Address - Zip Code:80840-2502
Practice Address - Country:US
Practice Address - Phone:719-333-5015
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-14
Last Update Date:2025-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZM5151762146L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, Paramedic