Provider Demographics
NPI:1740925346
Name:GILBERT, TREVA (PMHNP)
Entity type:Individual
Prefix:
First Name:TREVA
Middle Name:
Last Name:GILBERT
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 HUBER ST
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:MS
Mailing Address - Zip Code:39110-6983
Mailing Address - Country:US
Mailing Address - Phone:601-940-8132
Mailing Address - Fax:
Practice Address - Street 1:532 MAIN ST STE A
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:MS
Practice Address - Zip Code:39350-2562
Practice Address - Country:US
Practice Address - Phone:601-781-8677
Practice Address - Fax:601-676-0550
Is Sole Proprietor?:No
Enumeration Date:2022-04-28
Last Update Date:2022-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS905129363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner