Provider Demographics
NPI:1083681043
Name:GIBSON, ROGER M (ARNP)
Entity Type:Individual
Prefix:MR
First Name:ROGER
Middle Name:M
Last Name:GIBSON
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2840 SW URISH RD
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66614-5614
Mailing Address - Country:US
Mailing Address - Phone:785-228-2277
Mailing Address - Fax:785-228-9892
Practice Address - Street 1:2840 SW URISH RD
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66614-5614
Practice Address - Country:US
Practice Address - Phone:785-228-2277
Practice Address - Fax:785-228-9892
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS44639363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily