Provider Demographics
NPI:1538817366
Name:GIBBONS, COURTNEY KAY (AGACNP)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:KAY
Last Name:GIBBONS
Suffix:
Gender:F
Credentials:AGACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11512 KALINAGO VIEW LN
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77304-2272
Mailing Address - Country:US
Mailing Address - Phone:936-827-7730
Mailing Address - Fax:
Practice Address - Street 1:1111 MEDICAL PLAZA DR STE 250
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77380-3477
Practice Address - Country:US
Practice Address - Phone:281-296-8788
Practice Address - Fax:281-719-5933
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-10
Last Update Date:2022-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1072727363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care