Provider Demographics
NPI:1376519959
Name:GILBERT, DEBORAH JUNE (FNP-BC)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:JUNE
Last Name:GILBERT
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3810
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64803-3810
Mailing Address - Country:US
Mailing Address - Phone:417-347-8200
Mailing Address - Fax:417-347-8209
Practice Address - Street 1:3202 MCINTOSH CIR STE 103
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-3686
Practice Address - Country:US
Practice Address - Phone:417-347-8200
Practice Address - Fax:417-347-8209
Is Sole Proprietor?:No
Enumeration Date:2006-02-24
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO136816363L00000X
KS53-79657363L00000X
ARA01222363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR143598758Medicaid
AR10110026400OtherQUALCHOICE
AR143598758Medicaid