Individual
ANNA KATHERINE CLARK GIBSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
2521 GLENN HENDREN DR STE 108, LIBERTY, MO 64068-3388
(816) 781-3515
Mailing address
PO BOX 219672, KANSAS CITY, MO 64121-9672
(816) 407-4200
(816) 781-6973
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
2011007284
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
309393
—
SC
01
—
35789048
BCBS
MO
01
—
5909852
MEDICAID NC
NC
Enumeration date
07/13/2006
Last updated
07/21/2022
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