Provider Demographics
NPI:1154878247
Name:GIBSON, KAITLYN MARIE (MS, RN, CPNP-PC)
Entity type:Individual
Prefix:MS
First Name:KAITLYN
Middle Name:MARIE
Last Name:GIBSON
Suffix:
Gender:F
Credentials:MS, RN, CPNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 MOUNTAIN ROCK LN
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:MA
Mailing Address - Zip Code:02056-1772
Mailing Address - Country:US
Mailing Address - Phone:508-272-5720
Mailing Address - Fax:
Practice Address - Street 1:53 MARION RD
Practice Address - Street 2:
Practice Address - City:WAREHAM
Practice Address - State:MA
Practice Address - Zip Code:02571-1406
Practice Address - Country:US
Practice Address - Phone:508-295-8622
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-06
Last Update Date:2016-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2303234363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics