Organization
GIBBS WOUND CARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DEVONA D GIBBS FNP (NURSE PRACTITIONER)
(573) 686-4133
Entity
Organization
Contact information
Practice address
2210 BARRON RD, ROOM 205, POPLAR BLUFF, MO 63901-1908
(573) 686-4133
(573) 778-1099
Mailing address
2210 BARRON RD, ROOM 205, POPLAR BLUFF, MO 63901-1908
(573) 686-4133
(573) 778-1099
Taxonomy
Speciality
Code
Description
License number
State
363LC0200X
Critical Care Medicine Nurse Practitioner
Primary
0236239
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
064033
MISSOURI STATE BOARD OF NURSING
MO
Enumeration date
11/10/2015
Last updated
11/10/2015
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