Provider Demographics
NPI:1396127866
Name:GIBSON, EMMALEEN C (APRN-CNP)
Entity type:Individual
Prefix:MS
First Name:EMMALEEN
Middle Name:C
Last Name:GIBSON
Suffix:
Gender:F
Credentials:APRN-CNP
Other - Prefix:MS
Other - First Name:EMMALEEN
Other - Middle Name:
Other - Last Name:CAHILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:949 S INDIAN CREEK DR
Mailing Address - Street 2:
Mailing Address - City:TRAFALGAR
Mailing Address - State:IN
Mailing Address - Zip Code:46181-8659
Mailing Address - Country:US
Mailing Address - Phone:317-525-0046
Mailing Address - Fax:
Practice Address - Street 1:2220 N DRUID HILLS RD NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30329-3117
Practice Address - Country:US
Practice Address - Phone:404-785-7483
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-22
Last Update Date:2025-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.020824363LN0000X
FLAPRN11026509363LN0000X
IN71005584A363LN0005X
IL209023991363LN0005X, 363LN0005X
IN28187140A363LN0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0005XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal, Critical Care
Yes363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal