Doctor Name: | AMANDA GIBBONS |
NPI Number: | 1235546490 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | 2014023482 |
Business Practice Address: | 92 Main St Cassville, MO - 656251610 |
Business Phone Number: | 4178475225 |
Business Fax Number: | 4178475425 |
Mailing Address: | Po Box 505164, SAINT LOUIS |
State: | MO |
Postal Code: | 631505164 |
Phone Number: | 4178202000 |
Fax Number: | |
NPI Enumeration Date: | 07/18/2014 |
NPI Last Update Date: | 07/18/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 2014023482 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MO |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |