Provider Demographics
NPI:1306652854
Name:EGGLESTON, GABRIEL (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:GABRIEL
Middle Name:
Last Name:EGGLESTON
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 1:7052 KINGS LYNN LOOP
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-5902
Mailing Address - Country:US
Mailing Address - Phone:276-806-3873
Mailing Address - Fax:
Practice Address - Street 1:7052 KINGS LYNN LOOP
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-5902
Practice Address - Country:US
Practice Address - Phone:276-806-3873
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-09
Last Update Date:2024-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024192005363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health