Gibbons, Kellie J

Gibbons, Kellie J is an individual health care provider with primary practice located at 650 W State Street Winnebago County Jail Medical Unit, Rockford IL 61102-0000. She recently has 2 registered licenses in different health care specialties including Nursing Service Providers / Registered Nurse, Physician Assistants & Advanced Practice Nursing Providers / Adult Health. Nursing Service Providers / Registered Nurse is her primary health care specialty. Gibbons, Kellie J can be contacted via phone (815) 319-6630.

Contact Information

Primary practice address
650 W State Street Winnebago County Jail Medical Unit Rockford IL 61102-0000
Phone: (815) 319-6630
Fax: (815) 962-6425
Website:
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Health care specialties

SpecialtyCodeLicense #State
Nursing Service Providers / Registered Nurse 163W00000X 041335792 Illinois
Physician Assistants & Advanced Practice Nursing Providers / Adult Health 363LA2200X 209008646 Illinois

Profile Details

NPI number 1609173434
LBN Legal business name Gibbons, Kellie J
Credentials ANP-BC
Entity Individual
Sole proprietor 1 No
Enumeration date Feb 14th, 2011
Last updated Feb 14th, 2011 - about 15 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1609173434 NPPES
Illinois Other 041335792 RN LICENSE

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