Provider Demographics
NPI:1336034115
Name:GIBSON, CRYSTAL LEANNA (RN)
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:LEANNA
Last Name:GIBSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:CRYSTAL
Other - Middle Name:LEANNA
Other - Last Name:FREEMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:300 CEDAR RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:OZARK
Mailing Address - State:MO
Mailing Address - Zip Code:65721-8969
Mailing Address - Country:US
Mailing Address - Phone:417-559-5997
Mailing Address - Fax:417-559-5997
Practice Address - Street 1:300 CEDAR RIDGE RD
Practice Address - Street 2:
Practice Address - City:OZARK
Practice Address - State:MO
Practice Address - Zip Code:65721-8969
Practice Address - Country:US
Practice Address - Phone:417-559-5997
Practice Address - Fax:417-559-5997
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-11
Last Update Date:2025-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015028933163WG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0600XNursing Service ProvidersRegistered NurseGerontology