Provider Demographics
NPI:1326642141
Name:DAVIS, GABRIELLE GERLACH
Entity Type:Individual
Prefix:
First Name:GABRIELLE
Middle Name:GERLACH
Last Name:DAVIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 MOCKINGBIRD VALLEY RD APT 47
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-1357
Mailing Address - Country:US
Mailing Address - Phone:502-794-7827
Mailing Address - Fax:
Practice Address - Street 1:410 MOCKINGBIRD VALLEY RD APT 47
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-1357
Practice Address - Country:US
Practice Address - Phone:502-794-7827
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-23
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program