Kelly Gibson, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PAO8395 Issued in TX

Practice address

228 Saint George St
Gonzales, TX 78629-3910

Phone

(839) 672-6511

NPI assigned

Mar 5, 2013

Last updated

Nov 20, 2023By 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 TX

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

Physician Assistant

Education

Other, 2012

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Senior Psychcare of San Antonio I PLLCGroup PAC ID 8628241544, 13 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

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.

• Senior Psychcare of San Antonio I, PLLC

  • Psychiatry Physician
  • Houston, TX
  • NPI 1225324270
  Medicare reassignment Care Compare group
• Transitions Care Management PA

  • Internal Medicine Physician
  • Lubbock, TX
  • NPI 1609230010
  NPD (past)

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

{
    "created_epoch": "1362441600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1700438400000",
    "number": "1407197114",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1890",
            "city": "GONZALES",
            "state": "TX",
            "postal_code": "786291390",
            "telephone_number": "830-672-6511"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "228 SAINT GEORGE ST",
            "city": "GONZALES",
            "state": "TX",
            "postal_code": "786293910",
            "telephone_number": "839-672-6511"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GIBSON",
        "first_name": "KELLY",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-03-05",
        "last_updated": "2023-11-20",
        "certification_date": "2023-11-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TX",
            "license": "PAO8395",
            "primary": true
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "TX",
            "license": "1110177",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Gary James Gage, O.D.
• Gabriel Gallardo, M.ED., LPC
• Iris Galvez
• Gary J Gage
• Rosemary G Garza, DDS
• Kalli R Glass, DO
• Brianna Gail Goben, L.V.N.
• Gonzales County Emergency Services District 1 (Gonzales County Emergency Services)
• Gonzales County Senior Citizens Association, Inc
• Gonzales Dental PLLC

• Physician Assistant in Gonzales, TX
• Providers in Gonzales, TX by specialty
• Physician Assistant in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 20, 2023; 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.