Provider Demographics
NPI:1942099361
Name:GIBBONS, KELSEY DANIELLE (FNP-C)
Entity type:Individual
Prefix:MRS
First Name:KELSEY
Middle Name:DANIELLE
Last Name:GIBBONS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:KELSEY
Other - Middle Name:DANIELLE
Other - Last Name:VANAUKEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1218 GRACE MEADOW DR
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28115-2710
Mailing Address - Country:US
Mailing Address - Phone:704-838-6961
Mailing Address - Fax:
Practice Address - Street 1:146 E MCLELLAND AVE
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28115-2611
Practice Address - Country:US
Practice Address - Phone:980-920-3367
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-02
Last Update Date:2025-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCGIBB-VVSZH363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCGIBB-VVSZHOtherNCBON-NURSE PRACTITIONER
F02250706OtherAANP BOARD CERTIFICATION