Doctor Name: | BROOKE DANIELLE GIPSON |
NPI Number: | 1104291350 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | NP-C |
License Number: | 2015042865 |
Business Practice Address: | 423 E Logan St Moberly, MO - 652702222 |
Business Phone Number: | 6602636643 |
Business Fax Number: | 6602698453 |
Mailing Address: | 423 E Logan St, Po Box 488 MOBERLY |
State: | MO |
Postal Code: | 652702222 |
Phone Number: | 6602636643 |
Fax Number: | 6602694583 |
NPI Enumeration Date: | 12/13/2015 |
NPI Last Update Date: | 12/13/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 2015042865 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MO |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |