Individual
STACEY L GIBSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN, CPNP-PC
Contact information
Practice address
2401 GILLHAM RD, KANSAS CITY, MO 64108-4619
(816) 234-3982
(816) 802-1260
Mailing address
2401 GILLHAM RD, KANSAS CITY, MO 64108-4619
(816) 234-3982
(816) 802-1260
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
1393651041
KS
163W00000X
Registered Nurse
2005001915
MO
363LP0200X
Pediatric Nurse Practitioner
Primary
2005001915
MO
363LP0200X
Pediatric Nurse Practitioner
5375048041
KS
Other
Enumeration date
03/04/2010
Last updated
03/04/2010
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