Jamie Gibson, APN, NP-C

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

209015241 Issued in IL

Practice address

1850 Gateway Dr
Sycamore, IL 60178-3192

Phone

(815) 758-8671

Fax

(815) 756-4892

NPI assigned

Dec 8, 2016

Last updated

Dec 5, 2019By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1481155200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1575504000000",
    "number": "1174067227",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3598 HOUGHTBY RD",
            "city": "PAW PAW",
            "state": "IL",
            "postal_code": "613539582",
            "telephone_number": "815-761-4303"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1850 GATEWAY DR",
            "city": "SYCAMORE",
            "state": "IL",
            "postal_code": "601783192",
            "telephone_number": "815-758-8671",
            "fax_number": "815-756-4892"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3301 Resource Pkwy Ste 5",
            "address_purpose": "LOCATION",
            "city": "Dekalb",
            "state": "IL",
            "postal_code": "601155334",
            "country_code": "US",
            "telephone_number": "815-862-3489",
            "fax_number": "815-862-3490",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1850 Gateway Dr",
            "address_purpose": "LOCATION",
            "city": "Sycamore",
            "state": "IL",
            "postal_code": "601783192",
            "country_code": "US",
            "telephone_number": "815-758-8671",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GIBSON",
        "first_name": "JAMIE",
        "name_prefix": "Mrs.",
        "credential": "APN, NP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-12-08",
        "last_updated": "2019-12-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "IL",
            "license": "209015241",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Nurse Practitioner in Sycamore, IL
• Providers in Sycamore, IL by specialty
• Nurse Practitioner in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 5, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.