Provider Demographics
NPI:1811763527
Name:GIBBS, BERT (CPSS)
Entity type:Individual
Prefix:
First Name:BERT
Middle Name:
Last Name:GIBBS
Suffix:
Gender:M
Credentials:CPSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3710 CENTRAL AVE STE 14
Mailing Address - Street 2:
Mailing Address - City:KEARNEY
Mailing Address - State:NE
Mailing Address - Zip Code:68847-8126
Mailing Address - Country:US
Mailing Address - Phone:308-237-1102
Mailing Address - Fax:
Practice Address - Street 1:3710 CENTRAL AVE STE 14
Practice Address - Street 2:
Practice Address - City:KEARNEY
Practice Address - State:NE
Practice Address - Zip Code:68847-8126
Practice Address - Country:US
Practice Address - Phone:308-237-1102
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-04
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NECPSS-228175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist