| Doctor Name: | KELLY ANN GIBSON |
| NPI Number: | 1043559628 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | CRNP |
| License Number: | R165752 |
| Business Practice Address: | 6400 Greenfield Rd #908 Elkridge, MD - 210759101 |
| Business Phone Number: | 4107965917 |
| Business Fax Number: | |
| Mailing Address: | 6400 Greenfield Rd, #908 ELKRIDGE |
| State: | MD |
| Postal Code: | 210759101 |
| Phone Number: | 4107965917 |
| Fax Number: | |
| NPI Enumeration Date: | 02/02/2013 |
| NPI Last Update Date: | 04/08/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LA2100X |
| License Number: | R165752 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MD |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Acute Care |
| Taxonomy Definition: | |