Provider Demographics
NPI:1215196670
Name:GAMBINO, KELLY P (CRNP)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:P
Last Name:GAMBINO
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:999 LAKE HUNTER CIR STE D
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-5427
Mailing Address - Country:US
Mailing Address - Phone:843-375-0270
Mailing Address - Fax:
Practice Address - Street 1:999 LAKE HUNTER CIR STE D
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-5427
Practice Address - Country:US
Practice Address - Phone:843-375-0270
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-02
Last Update Date:2022-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATP002302Q363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner