Provider Demographics
NPI:1376329938
Name:GAMBLE, RALEY BROOKE
Entity Type:Individual
Prefix:
First Name:RALEY
Middle Name:BROOKE
Last Name:GAMBLE
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 1:219 S ARRINGTON DR
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:OK
Mailing Address - Zip Code:74074-3830
Mailing Address - Country:US
Mailing Address - Phone:918-630-4584
Mailing Address - Fax:
Practice Address - Street 1:219 S ARRINGTON DR
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:OK
Practice Address - Zip Code:74074-3830
Practice Address - Country:US
Practice Address - Phone:918-630-4584
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-07
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator