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1336034115 NPI number — CRYSTAL LEANNA GIBSON RN

NPI Number: 1336034115
Health Care Provider/Practitioner: CRYSTAL LEANNA GIBSON RN

Information about “1336034115” NPI (CRYSTAL LEANNA GIBSON RN) exists in 1336034115 in HTML format HTML  |  1336034115 in plain Text format TXT  |  1336034115 in PDF (Portable Document Format) PDF  |  1336034115 in an XML format XML  formats.

NPI Number : 1336034115 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1336034115",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "GIBSON",
    "FirstName": "CRYSTAL",
    "MiddleName": "LEANNA",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "RN",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "FREEMAN",
    "OtherFirstName": "CRYSTAL",
    "OtherMiddleName": "LEANNA",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": "RN",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "300 CEDAR RIDGE RD",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "OZARK",
    "MailingAddressStateName": "MO",
    "MailingAddressPostalCode": "65721-8969",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "417-559-5997",
    "MailingAddressFaxNumber": "417-559-5997",
    "FirstLinePracticeLocationAddress": "300 CEDAR RIDGE RD",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "OZARK",
    "PracticeLocationAddressStateName": "MO",
    "PracticeLocationAddressPostalCode": "65721-8969",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "417-559-5997",
    "PracticeLocationAddressFaxNumber": "417-559-5997",
    "EnumerationDate": "06/11/2025",
    "LastUpdateDate": "06/11/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "163WG0600X",
        "TaxonomyName": "Gerontology Registered Nurse",
        "LicenseNumber": "2015028933",
        "LicenseNumberStateCode": "MO",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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