William G Gibson IV, FNP-C
Individual provider Active NPI Family Nurse Practitioner · Rush City, MN
NPI 1003218876 · NPPES record last updated Aug 22, 2023
Key facts
- NPI
- 1003218876
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- 10136 (MN)
- Practice address
- 460 S Eliot Ave
Rush City, MN 55069-6505 - Phone
- (320) 358-0987
- Fax
- (320) 358-3422
- NPI assigned
- Sep 23, 2014
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2512775 | MN | MD | Registered Nurse |
| 10136 | MN | MD | Speech-Language Pathologist |
| COA.17029-NP | OH | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| All About Caring Home Care LLC | Current |
Accepting new patients | |
| All About Caring Home Care. Inc | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 2512775 | MN | |
| Family Nurse Practitioner | 363LF0000X | COA.17029-NP | OH | |
| Family Nurse Practitioner | 363LF0000X | 10136 | MN | Yes |
Addresses
Primary practice location
460 S Eliot Ave
Rush City, MN 55069-6505
Mailing address
PO Box 370
Rush City, MN 55069-0370
Phone (320) 358-0987
Other providers in Rush City, MN
- Amanda Cowan
- Dragonfly Children'S Respite Home Inc.
- Gretchen Ann Erickson
- Estates at Rush City LLC
- Fairview Clinics
- Kaitlyn Marie Grell I
- Diane Rose Hardee
- Delores M Kaiserlik
- William H E Kieper
- April Marie Klar
All providers in Rush City, MN · Family Nurse Practitioner in Minnesota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 22, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.