Individual
ALYSSA R GIBBS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
3132 OLD JACKSONVILLE RD, SPRINGFIELD, IL 62704-7400
(217) 862-0800
Mailing address
PO BOX 3428, SPRINGFIELD, IL 62708-3428
(800) 577-5368
(217) 757-2021
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
209009730
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2012009254
ANCC CERTIFICATION
IL
Enumeration date
08/29/2012
Last updated
08/29/2012
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