Provider Demographics
NPI:1275521874
Name:GABBERT, WRENNAH L (RN, CPNP, FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:WRENNAH
Middle Name:L
Last Name:GABBERT
Suffix:
Gender:F
Credentials:RN, CPNP, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2478 A AND M AVE
Mailing Address - Street 2:
Mailing Address - City:SAN ANGELO
Mailing Address - State:TX
Mailing Address - Zip Code:76904-5815
Mailing Address - Country:US
Mailing Address - Phone:325-223-9368
Mailing Address - Fax:325-942-2236
Practice Address - Street 1:2478 A AND M AVE
Practice Address - Street 2:
Practice Address - City:SAN ANGELO
Practice Address - State:TX
Practice Address - Zip Code:76904-5815
Practice Address - Country:US
Practice Address - Phone:325-223-9368
Practice Address - Fax:325-942-2236
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX232036363LF0000X, 363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Not Answered363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXFNP010625Medicaid