Healthcare Provider Details

I. General information

NPI: 1922942085
Provider Name (Legal Business Name): SHEMEKA GIBBS AGNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2026
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1075 US HIGHWAY 17 S
ELIZABETH CITY NC
27909-7628
US

IV. Provider business mailing address

2014 CEDAR POINT CIR
ELIZABETH CITY NC
27909-9694
US

V. Phone/Fax

Practice location:
  • Phone: 252-338-3975
  • Fax:
Mailing address:
  • Phone: 252-340-0204
  • Fax: 252-340-0204

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number5024367
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: