Provider Demographics
NPI:1407200603
Name:GENTRY, AMBERLY (FNP)
Entity Type:Individual
Prefix:
First Name:AMBERLY
Middle Name:
Last Name:GENTRY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 RING RD
Mailing Address - Street 2:
Mailing Address - City:HARRISON
Mailing Address - State:OH
Mailing Address - Zip Code:45030-2764
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:620 RING RD
Practice Address - Street 2:SUITE B
Practice Address - City:HARRISON
Practice Address - State:OH
Practice Address - Zip Code:45030-2764
Practice Address - Country:US
Practice Address - Phone:513-845-4558
Practice Address - Fax:513-845-4568
Is Sole Proprietor?:No
Enumeration Date:2016-04-14
Last Update Date:2017-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA.19000-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily