Healthcare Provider Details

I. General information

NPI: 1538817366
Provider Name (Legal Business Name): COURTNEY KAY GIBBONS AGACNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/10/2022
Last Update Date: 03/10/2022
Certification Date: 03/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 MEDICAL PLAZA DR STE 250
SPRING TX
77380-3477
US

IV. Provider business mailing address

11512 KALINAGO VIEW LN
CONROE TX
77304-2272
US

V. Phone/Fax

Practice location:
  • Phone: 281-296-8788
  • Fax: 281-719-5933
Mailing address:
  • Phone: 936-827-7730
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number1072727
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: