Healthcare Provider Details

I. General information

NPI: 1457431488
Provider Name (Legal Business Name): KAY A. GIBBONS RN, CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 03/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 W WILLIAM CANNON DR
AUSTIN TX
78745-5257
US

IV. Provider business mailing address

2500 W WILLIAM CANNON DR
AUSTIN TX
78745-5257
US

V. Phone/Fax

Practice location:
  • Phone: 512-326-9500
  • Fax:
Mailing address:
  • Phone: 512-326-9500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number435590
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: