Provider Demographics
NPI:1912000209
Name:GIBSON, KATHLEEN ANN (RN, CNS, CWOCN)
Entity Type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:ANN
Last Name:GIBSON
Suffix:
Gender:F
Credentials:RN, CNS, CWOCN
Other - Prefix:
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Other - Middle Name:
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Mailing Address - Street 1:3816 VERMEER DR
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95356-2404
Mailing Address - Country:US
Mailing Address - Phone:209-526-5176
Mailing Address - Fax:209-944-8374
Practice Address - Street 1:1800 N. CALIFORNIA ST.
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95213-9008
Practice Address - Country:US
Practice Address - Phone:209-943-2000
Practice Address - Fax:209-944-8374
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA472301163WE0900X
CA1422364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163WE0900XNursing Service ProvidersRegistered NurseEnterostomal Therapy
Not Answered364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP90222Medicare UPIN