Provider Demographics
NPI:1538754270
Name:GIBSON, CANDY MICHELLE (PMHNP-BC)
Entity type:Individual
Prefix:MS
First Name:CANDY
Middle Name:MICHELLE
Last Name:GIBSON
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 1:282 SPARTA SANDERS RD
Mailing Address - Street 2:
Mailing Address - City:SANDERS
Mailing Address - State:KY
Mailing Address - Zip Code:41083-9603
Mailing Address - Country:US
Mailing Address - Phone:502-545-0192
Mailing Address - Fax:
Practice Address - Street 1:326 ROLAND AVE
Practice Address - Street 2:
Practice Address - City:OWENTON
Practice Address - State:KY
Practice Address - Zip Code:40359
Practice Address - Country:US
Practice Address - Phone:859-578-3200
Practice Address - Fax:859-534-2627
Is Sole Proprietor?:No
Enumeration Date:2021-03-04
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3015824363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health