Individual
DEVONA J GIBBS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
196 TIMBER RIDGE TRL, POPLAR BLUFF, MO 63901-1595
(573) 686-4133
(573) 778-1099
Mailing address
196 TIMBER RIDGE TRL, ROOM 205, POPLAR BLUFF, MO 63901-1595
(573) 778-2888
(877) 610-3774
Taxonomy
Speciality
Code
Description
License number
State
363LC0200X
Critical Care Medicine Nurse Practitioner
Primary
064033
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
133802758
—
AR
05
—
428182034
—
MO
01
—
500000980
TRAVELERS MEDICARE
—
Enumeration date
01/04/2006
Last updated
08/25/2016
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