Provider Demographics
NPI:1053662775
Name:GIBSON, CARYN (PA-C)
Entity Type:Individual
Prefix:
First Name:CARYN
Middle Name:
Last Name:GIBSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 WINDING RIVER LN
Mailing Address - Street 2:SUITE 102
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22911-3568
Mailing Address - Country:US
Mailing Address - Phone:434-817-2442
Mailing Address - Fax:
Practice Address - Street 1:325 WINDING RIVER LN
Practice Address - Street 2:SUITE 102
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22911-3568
Practice Address - Country:US
Practice Address - Phone:434-817-2442
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-20
Last Update Date:2012-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110003094363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical