Provider Demographics
NPI:1073317418
Name:GILLIS, TABITHA SARA (FNP-C)
Entity type:Individual
Prefix:MS
First Name:TABITHA
Middle Name:SARA
Last Name:GILLIS
Suffix:
Gender:
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17888 SUNSET DR
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:MO
Mailing Address - Zip Code:64098-1000
Mailing Address - Country:US
Mailing Address - Phone:816-344-9611
Mailing Address - Fax:
Practice Address - Street 1:4400 BROADWAY BLVD STE 206
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64111-3342
Practice Address - Country:US
Practice Address - Phone:816-561-8100
Practice Address - Fax:816-561-8154
Is Sole Proprietor?:No
Enumeration Date:2025-04-03
Last Update Date:2025-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2025010733363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily