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General NPI Number Information
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NPI Number | 1386370500
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Entity Type | Individual
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Provider Name | KAYCIE RAYLYNN GILBREATH RN, FNP-C
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Gender | Female
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Dates
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Enumeration Date | 07/29/2022
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Last Update Date | 10/04/2022
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Provider Practice Location Address
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Address Line | 100 ELLIS AVENUE
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City | BOISE CITY
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State | OK
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Zip | 73933
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Country | US
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Telephone | 580-544-2501
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Fax | 580-544-3066
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Provider Business Mailing Address
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Address Line | 901 MAIN ST
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City | CLAYTON
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State | NM
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Zip | 88415-2917
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Country | US
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Telephone | 575-639-4592
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN-82110
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License Number State | NM
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 209632
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License Number State | OK
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