Provider Demographics
NPI:1558765362
Name:GIBBONS, MEGAN ELIZABETH (DNP, FNP-BC, NP-C)
Entity Type:Individual
Prefix:MS
First Name:MEGAN
Middle Name:ELIZABETH
Last Name:GIBBONS
Suffix:
Gender:F
Credentials:DNP, FNP-BC, NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:182 SEA ISLAND PKWY
Mailing Address - Street 2:
Mailing Address - City:LADYS ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29907-1503
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:182 SEA ISLAND PKWY
Practice Address - Street 2:
Practice Address - City:LADYS ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29907-1503
Practice Address - Country:US
Practice Address - Phone:843-322-1933
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-22
Last Update Date:2022-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL277000474363LF0000X
CO0001937363LF0000X
NC5014814363LF0000X
KY3016517363LF0000X
MO2014034211363LF0000X
SC23817363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily