Provider Demographics
NPI:1619910775
Name:GIBBLE, KAREN LYNN (APRN, BC)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:LYNN
Last Name:GIBBLE
Suffix:
Gender:F
Credentials:APRN, BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:604 MILLTOWN RD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19808-2227
Mailing Address - Country:US
Mailing Address - Phone:888-517-2088
Mailing Address - Fax:302-998-3242
Practice Address - Street 1:604 MILLTOWN RD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19808-2227
Practice Address - Country:US
Practice Address - Phone:888-517-2088
Practice Address - Fax:302-998-3242
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2014-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DELE-0000158364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1000025177Medicaid
DE1000025177Medicaid