Kellie J Gibbons, ANP-BC

Primary specialty

Registered NurseTaxonomy code 163W00000X

License

041335792 Issued in IL

Practice address

650 W State Street
Winnebago County Jail Medical Unit
Rockford, IL 61102-0000

Phone

(815) 319-6630

Fax

(815) 962-6425

NPI assigned

Feb 14, 2011

Last updated

Feb 14, 2011By 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 2

Addresses

Other identifiers 1

Other names 1

• Kellie J Meyer Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

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

{
    "created_epoch": "1297641600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1297641600000",
    "number": "1609173434",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "650 W STATE STREET",
            "address_2": "WINNEBAGO COUNTY JAIL MEDICAL UNIT",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611020000",
            "telephone_number": "815-319-6630",
            "fax_number": "815-962-6425"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "650 W STATE STREET",
            "address_2": "WINNEBAGO COUNTY JAIL MEDICAL UNIT",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611020000",
            "telephone_number": "815-319-6630",
            "fax_number": "815-962-6425"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GIBBONS",
        "first_name": "KELLIE",
        "middle_name": "J",
        "name_prefix": "Mrs.",
        "credential": "ANP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-02-14",
        "last_updated": "2011-02-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "IL",
            "license": "209008646",
            "primary": false
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "IL",
            "license": "041335792",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RN LICENSE",
            "identifier": "041335792",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KELLIE",
            "last_name": "MEYER",
            "middle_name": "J",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Amanda Navreet Ghuman, M.D.
• Nicole Theresa Giacopelli, DC
• William J Giakas, M.D.
• Marissa Ann Giannangeli, OTR/L
• Angela Giardono, FNP
• Madelyn Jo Gibbons
• Heather Renee Gibson, DNP
• Taylor Gibson
• Rebecca Gielow, LCPC
• Jacqueline F Gifford

• Registered Nurse in Rockford, IL
• Providers in Rockford, IL by specialty
• Registered Nurse in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 14, 2011; 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.