Provider Demographics
NPI:1508171505
Name:GIBBONS, KRISTEL FULLER (FNP)
Entity Type:Individual
Prefix:
First Name:KRISTEL
Middle Name:FULLER
Last Name:GIBBONS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:KRISTEL
Other - Middle Name:KATHERINE
Other - Last Name:FULLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:3403 TAZEWELL PIKE STE 102
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37918-2621
Mailing Address - Country:US
Mailing Address - Phone:865-689-9966
Mailing Address - Fax:865-689-0910
Practice Address - Street 1:3403 TAZEWELL PIKE STE 102
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37918-2621
Practice Address - Country:US
Practice Address - Phone:865-689-9966
Practice Address - Fax:865-689-0910
Is Sole Proprietor?:No
Enumeration Date:2010-08-13
Last Update Date:2020-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN15132363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily