Active NPI
Caryn Gibson, PA-C
- Medical Physician Assistant
- Charlottesville, VA
National Provider Identifier
1053662775
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Medical Physician Assistant
- License
- 0110003094
- Practice address
- 325 Winding River LN
Suite 102
Charlottesville, VA 22911-3568 - Phone
- (434) 817-2442
- NPI assigned
- Sep 20, 2012
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | 0110003094 | VA | Primary |
Addresses
Primary practice location
325 Winding River LN
Suite 102
Charlottesville, VA 22911-3568
Mailing address
325 Winding River LN
Suite 102
Charlottesville, VA 22911-3568
Phone (434) 817-2442
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0110003094 | VA | MD | Medical Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1348099200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1348099200000",
"number": "1053662775",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "325 WINDING RIVER LN",
"address_2": "SUITE 102",
"city": "CHARLOTTESVILLE",
"state": "VA",
"postal_code": "229113568",
"telephone_number": "434-817-2442"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "325 WINDING RIVER LN",
"address_2": "SUITE 102",
"city": "CHARLOTTESVILLE",
"state": "VA",
"postal_code": "229113568",
"telephone_number": "434-817-2442"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GIBSON",
"first_name": "CARYN",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-09-20",
"last_updated": "2012-09-20",
"status": "A"
},
"taxonomies": [
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": "VA",
"license": "0110003094",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Charlottesville, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 20, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.