Provider Demographics
NPI:1235520388
Name:GIBSON, DONNA (FNP)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:
Last Name:GIBSON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9
Mailing Address - Street 2:14558 DANVILLE PIKE
Mailing Address - City:LAUREL FORK
Mailing Address - State:VA
Mailing Address - Zip Code:24352-0009
Mailing Address - Country:US
Mailing Address - Phone:276-398-2292
Mailing Address - Fax:276-398-3331
Practice Address - Street 1:14558 DANVILLE PIKE
Practice Address - Street 2:
Practice Address - City:LAUREL FORK
Practice Address - State:VA
Practice Address - Zip Code:24352-3982
Practice Address - Country:US
Practice Address - Phone:276-398-2292
Practice Address - Fax:276-398-3331
Is Sole Proprietor?:No
Enumeration Date:2015-02-11
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001138056163W00000X
VA024172361363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse