Individual provider Active NPI

Kelsey Mae Maffett Gibson, NP

  • Nurse Practitioner
  • Kernersville, NC
National Provider Identifier
1477204659
Registry record updated Sep 11, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
5015717 Issued in NC
Practice address
1696 Ridgestone LN
Kernersville, NC 27284-6644
Phone
(336) 970-1068
NPI assigned
Jan 10, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 11, 2025

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 5015717 NC Primary
Critical Care Medicine Registered Nurse 163WC0200X 294297 NC
Family Nurse Practitioner 363LF0000X 5015717 NC

Addresses

Primary practice location

1696 Ridgestone LN
Kernersville, NC 27284-6644

Mailing address

PO Box 751803
Charlotte, NC 28275-1803

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
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

Enrollment IDStateProvider typePAC IDDetails
I20220311000313 NC Practitioner - Nurse Practitioner 9931594850 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Forsyth Memorial Hospital IncGroup PAC ID 9537071790, 622 clinicians

Practice addresses (Care Compare)

100 Robinhood Medical PLZ
Winston Salem, NC 27106-5476
Phone (336) 718-0800

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
294297NCMDCritical Care Medicine Registered Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
Tanglewood Park Physicians, PLLC CurrentSince Apr 1, 2024 Accepting new patients
Forsyth Memorial Hospital, Inc. CurrentSince Feb 13, 2022 Accepting new patients
Novant Health Medical Group, LLC CurrentSince May 30, 2023 Accepting new patients
Novant Health Medical Group, LLC Current Accepting new patients
Kernersville Emergency Group, PLLC CurrentSince Apr 1, 2024 Accepting new patients
Piedmont Triad Physicians, PLLC CurrentSince Apr 1, 2024 Accepting new patients
Novant Health Medical Group, LLC CurrentSince May 30, 2023 Accepting new patients
Forsyth Memorial Hospital, Inc. CurrentSince Feb 13, 2022 Accepting new patients
Forsyth Memorial Hospital, Inc Past Accepting new patients

Locations

10810 Mallard Creek Rd
Charlotte, NC 28262
Phone (704) 510-8000

6301 Stadium Dr
Clemmons, NC 27012
Phone (336) 766-6473

6915 Village Medical Cir
Clemmons, NC 27012
Phone (336) 718-1680

291 Broad St
Kernersville, NC 27284
Phone (336) 993-8181

1750 Kernersville Medical Pkwy
Kernersville, NC 27284
Phone (336) 564-4000

207 Old Lexington Rd
Thomasville, NC 27360
Phone (336) 472-2000

390 W Salem Ave
Winston Salem, NC 27101
Phone (336) 721-2375

105 Vest Mill Cir
Winston Salem, NC 27103
Phone (336) 718-7800

100 Robinhood Medical Plz
Winston Salem, NC 27106
Phone (336) 718-0560

2825 Lyndhurst Ave
Ste 101
Winston Salem, NC 27103
Phone (336) 277-6300

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/14272/brand/70/csg/1/fhir/r4
  • Direct secure messaging: kmaffett438744@direct.novanthealth.org

Organizations & group practices 9

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

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1641772800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1757548800000",
    "number": "1477204659",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 751803",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282751803"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1696 RIDGESTONE LN",
            "city": "KERNERSVILLE",
            "state": "NC",
            "postal_code": "272846644",
            "telephone_number": "336-970-1068"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAFFETT GIBSON",
        "first_name": "KELSEY",
        "middle_name": "MAE",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-01-10",
        "last_updated": "2025-09-11",
        "certification_date": "2025-09-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NC",
            "license": "5015717",
            "primary": true
        },
        {
            "code": "163WC0200X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Critical Care Medicine",
            "state": "NC",
            "license": "294297",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NC",
            "license": "5015717",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kernersville, NC

Sources for this page

Verify at the official NPI Registry.