Provider Demographics
NPI:1730624701
Name:GILBERT, ALISSON (PMHNP-BC, AGNP-C)
Entity type:Individual
Prefix:
First Name:ALISSON
Middle Name:
Last Name:GILBERT
Suffix:
Gender:F
Credentials:PMHNP-BC, AGNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1769 JAMESTOWN RD STE 110
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23185-2310
Mailing Address - Country:US
Mailing Address - Phone:757-828-2375
Mailing Address - Fax:757-794-4675
Practice Address - Street 1:1769 JAMESTOWN RD STE 110
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23185-2310
Practice Address - Country:US
Practice Address - Phone:757-828-2375
Practice Address - Fax:757-794-4675
Is Sole Proprietor?:No
Enumeration Date:2016-12-30
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP9753363L00000X, 363LP0808X
VA0024180249363LA2200X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ234663Medicaid