MEDICARE: MRS. KAY A. GIBBONS RN, CPNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0200X	Pediatric Nurse Practitioner	435590	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	0917973-05	OTHER	TX	CHIP

General Provider Information

NPI Number	:	1457431488
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KAY A. GIBBONS RN, CPNP

Provider Business Mailing Address
First Line	:	2500 W WILLIAM CANNON DR
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78745-5257
Country	:	US
Telephone Number	:	512-326-9500
Fax Number	:

Provider Business Practice Location Address
First Line	:	2500 W WILLIAM CANNON DR
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78745-5257
Country	:	US
Telephone Number	:	512-326-9500
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/16/2006
Last Update Date	:	03/20/2015

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