Active NPI
Kellie Gibson
- Behavior Technician
- Saint Louis, MO
National Provider Identifier
1124905211
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- Practice address
- 2055 Craigshire Dr Ste 410
Saint Louis, MO 63146-4012 - Phone
- (314) 200-2140
- NPI assigned
- Aug 19, 2025
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Technician | 106S00000X | Primary |
Addresses
Primary practice location
2055 Craigshire Dr Ste 410
Saint Louis, MO 63146-4012
Mailing address
277 E Amador Ave Ste 101
Las Cruces, NM 88001-3675
Phone (505) 392-3482
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1755561600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1755561600000",
"number": "1124905211",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "277 E AMADOR AVE STE 101",
"city": "LAS CRUCES",
"state": "NM",
"postal_code": "880013675",
"telephone_number": "505-392-3482"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2055 CRAIGSHIRE DR STE 410",
"city": "SAINT LOUIS",
"state": "MO",
"postal_code": "631464012",
"telephone_number": "314-200-2140"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GIBSON",
"first_name": "KELLIE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2025-08-19",
"last_updated": "2025-08-19",
"certification_date": "2025-08-19",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Saint Louis, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.