Provider Demographics
NPI:1679001754
Name:GIBBENS, AMY MARIE (FNP-C)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:MARIE
Last Name:GIBBENS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2820 E ROCK HAVEN RD STE 100
Mailing Address - Street 2:
Mailing Address - City:HARRISONVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:64701-4413
Mailing Address - Country:US
Mailing Address - Phone:816-380-3582
Mailing Address - Fax:816-380-6964
Practice Address - Street 1:2820 E ROCK HAVEN RD STE 100
Practice Address - Street 2:
Practice Address - City:HARRISONVILLE
Practice Address - State:MO
Practice Address - Zip Code:64701-4413
Practice Address - Country:US
Practice Address - Phone:816-380-3582
Practice Address - Fax:816-380-6964
Is Sole Proprietor?:No
Enumeration Date:2017-06-01
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2017016966363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily