Provider Demographics
NPI:1811527096
Name:GIBBS, KEVIN SCOTT (RN)
Entity type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:SCOTT
Last Name:GIBBS
Suffix:
Gender:M
Credentials:RN
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Mailing Address - Street 1:6668 FOURTH SECTION RD
Mailing Address - Street 2:
Mailing Address - City:BROCKPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14420-2448
Mailing Address - Country:US
Mailing Address - Phone:585-368-6870
Mailing Address - Fax:585-368-6871
Practice Address - Street 1:6668 FOURTH SECTION RD
Practice Address - Street 2:
Practice Address - City:BROCKPORT
Practice Address - State:NY
Practice Address - Zip Code:14420-2448
Practice Address - Country:US
Practice Address - Phone:585-368-6870
Practice Address - Fax:585-368-6871
Is Sole Proprietor?:No
Enumeration Date:2020-01-16
Last Update Date:2023-03-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY717458-1163WM0705X
NY347986363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical