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General NPI Number Information
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NPI Number | 1891813572
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Entity Type | Individual
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Provider Name | KIM GIBSON RN
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Gender | Female
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Dates
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Enumeration Date | 03/27/2007
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Last Update Date | 04/06/2022
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Provider Practice Location Address
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Address Line | 16405 SUNNY GLENN AVE
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City | CLEVELAND
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State | OH
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Zip | 44128-3776
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Country | US
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Telephone | 216-801-9792
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Fax |
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Provider Business Mailing Address
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Address Line | 16405 SUNNY GLENN AVE
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City | CLEVELAND
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State | OH
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Zip | 44128-3776
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Country | US
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Telephone | 216-612-1008
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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 | CNP.0031125
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN378521
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License Number State | OH
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