Healthcare Provider Details

I. General information

NPI: 1346045895
Provider Name (Legal Business Name): JAYNE GIBBS ADN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/18/2025
Last Update Date: 02/18/2025
Certification Date: 02/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15512 W. 113TH STREET
LENEXA KS
66219
US

IV. Provider business mailing address

15512 W 113TH ST
LENEXA KS
66219-5100
US

V. Phone/Fax

Practice location:
  • Phone: 816-922-2641
  • Fax:
Mailing address:
  • Phone: 816-922-2641
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number2000162259
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: