Provider Demographics
NPI:1427590082
Name:GIBSON, JESSIE SELLERS (PHD, MSN, AGPCNP-BC)
Entity type:Individual
Prefix:DR
First Name:JESSIE
Middle Name:SELLERS
Last Name:GIBSON
Suffix:
Gender:F
Credentials:PHD, MSN, AGPCNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1215 LEE ST
Mailing Address - Street 2:PO BOX 800659
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22908
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1215 LEE STREET
Practice Address - Street 2:PO BOX 800659
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22908
Practice Address - Country:US
Practice Address - Phone:434-924-2706
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-14
Last Update Date:2024-07-11
Deactivation Date:2021-01-08
Deactivation Code:
Reactivation Date:2024-07-09
Provider Licenses
StateLicense IDTaxonomies
VA0024180937363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health