NPI
Starr'Retiece R Gibson
This page is a copy of the public NPPES file.
Facts
- Status
- Active
- Credential
- Licensed Dietitian
- Type
- Individual
- Enumeration date
- 2024-11-19
- Last updated
- 2024-11-19
Specialties
Licenses
- License IL
- 164.008825
Location
- Practice location
- 2071 Goose Lake Rd
- City
- Sauget IL
- Postal code
- 62206-2822
- Phone
- (618) 857-2700
Medicare
- PECOS
- No PECOS enrollment row matched this NPI.
LEIE
No exclusion found for this NPI in the OIG LEIE file dated October 9, 2026. OIG's online search is the official check.
Nearby
Other NPIs in Sauget, IL. 11 records in the public file.
Removal request
Public data from NPPES and CMS. Not a credentialing determination.
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