Healthcare Provider Details

I. General information

NPI: 1942461884
Provider Name (Legal Business Name): KIRSTEN GIBBS NIETO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KIRSTEN INGLEE GIBBS M.D.

II. Dates (important events)

Enumeration Date: 06/23/2008
Last Update Date: 01/31/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4900 MUELLER BLVD UT SOUTHWESTERN AUSTIN PEDIATRICS
AUSTIN TX
78723-3079
US

IV. Provider business mailing address

12017 PALISADES PKWY
AUSTIN TX
78732-1243
US

V. Phone/Fax

Practice location:
  • Phone: 888-323-7277
  • Fax: 512-324-0786
Mailing address:
  • Phone: 713-870-1465
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberTMB N8049
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberN8049
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: