Provider Demographics
NPI:1376156695
Name:GIBBS GREEN, KAREN RENEE
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:RENEE
Last Name:GIBBS GREEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11502 YOAKUM ST
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-5711
Mailing Address - Country:US
Mailing Address - Phone:713-303-3434
Mailing Address - Fax:
Practice Address - Street 1:11502 YOAKUM ST
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584-5711
Practice Address - Country:US
Practice Address - Phone:713-303-3434
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-26
Last Update Date:2020-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX608423163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX608423OtherRN LICENSURE