Individual
CODY J. GIBBS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP-C
Contact information
Practice address
180 S MAIN ST, CANTON, IL 61520-2608
(309) 647-0201
(309) 649-6880
Mailing address
180 S MAIN ST, CANTON, IL 61520-2608
(309) 647-0201
(309) 649-6880
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
209017218
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
209017218
APN LICENSE
IL
Enumeration date
02/02/2018
Last updated
04/13/2021
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