Provider Demographics
NPI:1477006856
Name:CANIGLIA, GABRIELLE (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:GABRIELLE
Middle Name:
Last Name:CANIGLIA
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:714 LYNDON LN STE 6
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40222-4643
Mailing Address - Country:US
Mailing Address - Phone:502-326-8600
Mailing Address - Fax:502-326-8970
Practice Address - Street 1:714 LYNDON LN STE 6
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40222-4643
Practice Address - Country:US
Practice Address - Phone:502-326-8600
Practice Address - Fax:502-326-8970
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-02
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3010557363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health