Healthcare Provider Details

I. General information

NPI: 1215187679
Provider Name (Legal Business Name): SARAH L. GIBBONS CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2008
Last Update Date: 01/31/2020
Certification Date: 01/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1313 VETERANS AVENUE SUITE C
CRYSTAL CITY TX
78839-3724
US

IV. Provider business mailing address

403 S. 7TH STREET
CARRIZO SPRINGS TX
78834-4204
US

V. Phone/Fax

Practice location:
  • Phone: 830-374-4436
  • Fax: 830-374-4437
Mailing address:
  • Phone: 830-876-9870
  • Fax: 830-876-3661

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number578107
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberAP115374
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: