Provider Demographics
NPI:1629883129
Name:GIBSON, KALYNN RAY (APRN, CNP)
Entity type:Individual
Prefix:
First Name:KALYNN
Middle Name:RAY
Last Name:GIBSON
Suffix:
Gender:F
Credentials:APRN, CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:94 CHARLES GIBSON RD
Mailing Address - Street 2:
Mailing Address - City:FRAKES
Mailing Address - State:KY
Mailing Address - Zip Code:40940-9088
Mailing Address - Country:US
Mailing Address - Phone:606-337-3657
Mailing Address - Fax:
Practice Address - Street 1:94 CHARLES GIBSON RD
Practice Address - Street 2:
Practice Address - City:FRAKES
Practice Address - State:KY
Practice Address - Zip Code:40940-9088
Practice Address - Country:US
Practice Address - Phone:606-337-3657
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-11
Last Update Date:2025-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4035263363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily