Healthcare Provider Details

I. General information

NPI: 1891405916
Provider Name (Legal Business Name): DANIELLE LORIEL GIBSON APRN, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2022
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9049 SPRINGBORO PIKE
MIAMISBURG OH
45342-4926
US

IV. Provider business mailing address

611 SAINT JOSEPH AVE APT 6B3
DAYTON OH
45410-2264
US

V. Phone/Fax

Practice location:
  • Phone: 937-759-0545
  • Fax:
Mailing address:
  • Phone: 937-321-4355
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number509821
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code163WA0400X
TaxonomyAddiction (Substance Use Disorder) Registered Nurse
License Number509821
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number509821
License Number StateOH
# 4
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN.CNP.0043398
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: