Collette C Gibbons NP LLC

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

Legal business name

COLLETTE C GIBBONS NP LLC

Doing business as

Southpointe Psychiatry & Wellness

Practice address

135 Technology Dr Ste 204
Canonsburg, PA 15317-9549

Phone

(724) 399-3931

Fax

(724) 618-3853

NPI assigned

Oct 9, 2023

Last updated

May 6, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Collette C Gibbons, CRNPNPI 1275637837

Title

Owner

Phone

(412) 719-9176

Specialties & licenses 1

Addresses

Other names 1

• Southpointe Psychiatry & Wellness Doing business as

Medicare fee-for-service enrollment

Enrolled in PA

Enrollment records 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Collette Gibbons, MSN, PMHNP, FNP

  • Psychiatric/Mental Health Nurse Practitioner
  • Canonsburg, PA
  • NPI 1275637837

  Single Specialty

  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1696809600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1714953600000",
    "number": "1407637374",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "343 OAK FOREST DR",
            "city": "PITTSBURGH",
            "state": "PA",
            "postal_code": "152161122",
            "telephone_number": "412-719-9176"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "135 TECHNOLOGY DR STE 204",
            "city": "CANONSBURG",
            "state": "PA",
            "postal_code": "153179549",
            "telephone_number": "724-399-3931",
            "fax_number": "724-618-3853"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COLLETTE C GIBBONS NP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-10-09",
        "last_updated": "2024-05-06",
        "certification_date": "2024-05-06",
        "status": "A",
        "authorized_official_last_name": "GIBBONS",
        "authorized_official_first_name": "COLLETTE",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "412-719-9176",
        "authorized_official_credential": "CRNP"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Southpointe Psychiatry & Wellness",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Southpointe Psychiatry & Wellness",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Psychiatric/Mental Health Nurse Practitioner in Canonsburg, PA
• Providers in Canonsburg, PA by specialty
• Psychiatric/Mental Health Nurse Practitioner in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 6, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.