Kourtney Sharda Gibson, PMHNP-BC

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

APRN-NP273930 Issued in GA

Practice address

3441 Cypress Mill Rd Ste 101
Brunswick, GA 31520-2879

Phone

(912) 275-4763

NPI assigned

Mar 21, 2024

Last updated

Sep 8, 2025By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2024

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Personal Recovery Network LLCGroup PAC ID 5092611384, 612 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Personal Recovery Network LLC

  dba LifeStance Health

  • Psychiatry Physician
  • Stockbridge, GA
  • NPI 1881990869
  Medicare reassignment Care Compare group NPD
• Gateway Community Service Board

  • Community/Behavioral Health Agency
  • Brunswick, GA
  • NPI 1558478214
  Medicare reassignment NPD
• Lifesource of North Carolina

  dba LifeSource of Georgia

  • General Practice Physician
  • Rome, GA
  • NPI 1962940817
  Medicare reassignment NPD
• Gateway Behavioral Health Services

  • Mental Illness Community Based Residential Treatment Facility
  • Brunswick, GA
  • NPI 1124254321
  NPD
• Lifesource of North Carolina

  • Psychologist
  • Milton, FL
  • NPI 1730648288

  Psychiatric/Mental Health

  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1710979200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1757289600000",
    "number": "1386404630",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "810 WARREN MASON BLVD UNIT 702",
            "city": "BRUNSWICK",
            "state": "GA",
            "postal_code": "315201333",
            "telephone_number": "912-324-1651"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3441 CYPRESS MILL RD STE 101",
            "city": "BRUNSWICK",
            "state": "GA",
            "postal_code": "315202879",
            "telephone_number": "912-275-4763"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1345 Redmond Cir NW",
            "address_purpose": "LOCATION",
            "city": "Rome",
            "state": "GA",
            "postal_code": "301651307",
            "country_code": "US",
            "telephone_number": "910-742-9243",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GIBSON",
        "first_name": "KOURTNEY",
        "middle_name": "SHARDA",
        "credential": "PMHNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-03-21",
        "last_updated": "2025-09-08",
        "certification_date": "2025-09-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "GA",
            "license": "APRN-NP273930",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "GA",
            "license": "RN273930",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Georgia Nurse Care, LLC
• Wendy Watkins Gerken, RPH
• Fatima Ghaffar, M.D.
• Habban Ghani
• GHC-Brunswick, LLC (GHC Hospice)
• Chandler Giedl
• Giva, Inc. (Visiting Angles of SE GA)
• Mark Glaude
• Lori Lynette Glover, NP
• Glynn Anesthesia Associates, Inc.

• Psychiatric/Mental Health Nurse Practitioner in Brunswick, GA
• Providers in Brunswick, GA by specialty
• Psychiatric/Mental Health Nurse Practitioner in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 8, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.