Healthcare Provider Details

I. General information

NPI: 1427003656
Provider Name (Legal Business Name): DAWNA LYNN GILBERT ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 S M-291 HWY
INDEPENDENCE MO
64057-1201
US

IV. Provider business mailing address

105 N ROGERS ST
INDEPENDENCE MO
64050-4014
US

V. Phone/Fax

Practice location:
  • Phone: 816-373-9328
  • Fax: 816-373-9207
Mailing address:
  • Phone: 816-254-4728
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number100194
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: