Provider Demographics
NPI:1932101631
Name:GIBSON, ERICA ELLIS (MD)
Entity Type:Individual
Prefix:DR
First Name:ERICA
Middle Name:ELLIS
Last Name:GIBSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8350 N CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64158-1104
Mailing Address - Country:US
Mailing Address - Phone:913-297-7472
Mailing Address - Fax:
Practice Address - Street 1:8350 N CHURCH RD
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64158-1104
Practice Address - Country:US
Practice Address - Phone:913-297-7472
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2022-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-29201207Q00000X
MO2011027717207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100402440AMedicaid
KS100402440AMedicaid