Individual
MRS. KELLIE J GIBBONS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ANP-BC
Contact information
Practice address
650 W STATE STREET, WINNEBAGO COUNTY JAIL MEDICAL UNIT, ROCKFORD, IL 61102-0000
(815) 319-6630
(815) 962-6425
Mailing address
650 W STATE STREET, WINNEBAGO COUNTY JAIL MEDICAL UNIT, ROCKFORD, IL 61102-0000
(815) 319-6630
(815) 962-6425
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
041335792
IL
363LA2200X
Adult Health Nurse Practitioner
209008646
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
041335792
RN LICENSE
IL
Enumeration date
02/14/2011
Last updated
02/14/2011
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