Healthcare Provider Details

I. General information

NPI: 1952285488
Provider Name (Legal Business Name): KAMI LEIGH GIBSON FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2025
Last Update Date: 09/08/2025
Certification Date: 09/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

534 MAPLE VALLEY DR
FARMINGTON MO
63640-1981
US

IV. Provider business mailing address

PO BOX 957683
SAINT LOUIS MO
63195-7683
US

V. Phone/Fax

Practice location:
  • Phone: 573-760-8253
  • Fax:
Mailing address:
  • Phone: 573-760-8253
  • Fax: 314-996-4500

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number20250034153
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2025034153
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number2014032099
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: