Healthcare Provider Details

I. General information

NPI: 1225275548
Provider Name (Legal Business Name): JAMIE LYNN GIBSON FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JAMIE LYNN KEDDY FNP

II. Dates (important events)

Enumeration Date: 01/08/2009
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 STATE HIGHWAY 310 STE 1
CANTON NY
13617-1436
US

IV. Provider business mailing address

80 STATE HIGHWAY 310 STE 1
CANTON NY
13617-1436
US

V. Phone/Fax

Practice location:
  • Phone: 315-386-2189
  • Fax:
Mailing address:
  • Phone: 315-386-2189
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF350233
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number555402
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: