Provider Demographics
NPI:1083482384
Name:GIBSON, KAYLEIGH M (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:KAYLEIGH
Middle Name:M
Last Name:GIBSON
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4099 ANN ELISE CT
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD TOWNSHIP
Mailing Address - State:OH
Mailing Address - Zip Code:45011-6210
Mailing Address - Country:US
Mailing Address - Phone:513-320-0441
Mailing Address - Fax:
Practice Address - Street 1:4099 ANN ELISE CT
Practice Address - Street 2:
Practice Address - City:FAIRFIELD TOWNSHIP
Practice Address - State:OH
Practice Address - Zip Code:45011-6210
Practice Address - Country:US
Practice Address - Phone:513-320-0441
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-15
Last Update Date:2024-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.0038239363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health