Healthcare Provider Details

I. General information

NPI: 1083007843
Provider Name (Legal Business Name): KILEY R GILBERT PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2015
Last Update Date: 08/13/2021
Certification Date: 08/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1802 W 4TH ST
WILMINGTON DE
19805-3420
US

IV. Provider business mailing address

816 LARVIK LN
STOUGHTON WI
53589-5313
US

V. Phone/Fax

Practice location:
  • Phone: 302-655-5822
  • Fax:
Mailing address:
  • Phone: 97-216-3393
  • Fax: 503-352-8658

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number0992260
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number7179
License Number StateMN
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number202004476NP-PP
License Number StateOR
# 4
Primary TaxonomyN
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License Number1631093
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: