Basic Information
| Provider Information | |||||||||
| NPI: | 1861928061 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GIBSON | ||||||||
| FirstName: | EMILY | ||||||||
| MiddleName: | JANE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7900 LEES SUMMIT RD | ||||||||
| Address2: | |||||||||
| City: | KANSAS CITY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 641391246 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8164044862 | ||||||||
| FaxNumber: | 8164047716 | ||||||||
| Practice Location | |||||||||
| Address1: | 1004 CARONDELET DR | ||||||||
| Address2: | |||||||||
| City: | KANSAS CITY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 641144801 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8169437777 | ||||||||
| FaxNumber: | 8169437778 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/08/2017 | ||||||||
| LastUpdateDate: | 04/13/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/13/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | MD2020-0034 | NM | N | Allopathic & Osteopathic Physicians | Family Medicine | 207QS0010X | 2020013275 | MO | N | Allopathic & Osteopathic Physicians | Family Medicine | Sports Medicine | 207QS0010X | 2022010840 | MO | N | Allopathic & Osteopathic Physicians | Family Medicine | Sports Medicine | 207Q00000X | 2022010840 | MO | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.