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General NPI Number Information
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NPI Number | 1073317418
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Entity Type | Individual
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Provider Name | TABITHA SARA GILLIS FNP-C
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Gender | Female
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Dates
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Enumeration Date | 04/03/2025
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Last Update Date | 04/03/2025
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Provider Practice Location Address
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Address Line | 4400 BROADWAY BLVD STE 206
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City | KANSAS CITY
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State | MO
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Zip | 64111-3342
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Country | US
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Telephone | 816-561-8100
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Fax | 816-561-8154
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Provider Business Mailing Address
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Address Line | 17888 SUNSET DR
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City | WESTON
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State | MO
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Zip | 64098-1000
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Country | US
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Telephone | 816-344-9611
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 2025010733
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License Number State | MO
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