Provider Demographics
NPI:1215915889
Name:GIBBS, DEVONA J (FNP)
Entity type:Individual
Prefix:
First Name:DEVONA
Middle Name:J
Last Name:GIBBS
Suffix:
Gender:F
Credentials:FNP
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Mailing Address - Street 1:196 TIMBER RIDGE TRL
Mailing Address - Street 2:ROOM 205
Mailing Address - City:POPLAR BLUFF
Mailing Address - State:MO
Mailing Address - Zip Code:63901-1595
Mailing Address - Country:US
Mailing Address - Phone:573-778-2888
Mailing Address - Fax:877-610-3774
Practice Address - Street 1:196 TIMBER RIDGE TRL
Practice Address - Street 2:
Practice Address - City:POPLAR BLUFF
Practice Address - State:MO
Practice Address - Zip Code:63901-1595
Practice Address - Country:US
Practice Address - Phone:573-686-4133
Practice Address - Fax:573-778-1099
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-04
Last Update Date:2016-08-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO064033363LC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LC0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO428182034Medicaid
AR133802758Medicaid
500000980OtherTRAVELERS MEDICARE
MO428182034Medicaid