Provider Demographics
NPI:1619546785
Name:GIBSON, SARAH ELIZABETH BURKEY (CRNP-PMH)
Entity Type:Individual
Prefix:MS
First Name:SARAH
Middle Name:ELIZABETH BURKEY
Last Name:GIBSON
Suffix:
Gender:F
Credentials:CRNP-PMH
Other - Prefix:MS
Other - First Name:SARAH
Other - Middle Name:ELIZABETH
Other - Last Name:BURKEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:10770 COLUMBIA PIKE STE NO1099
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20901-4402
Mailing Address - Country:US
Mailing Address - Phone:301-941-7077
Mailing Address - Fax:833-333-1392
Practice Address - Street 1:10770 COLUMBIA PIKE STE NO1099
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20901-4402
Practice Address - Country:US
Practice Address - Phone:301-941-7077
Practice Address - Fax:833-333-1392
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-22
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR242034363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDR242034OtherMBON