Provider Demographics
NPI:1508196346
Name:MCGINTY-GAMBLE, WENDY (PA-C)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:
Last Name:MCGINTY-GAMBLE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12201 RENFERT WAY STE 225
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78758-5369
Mailing Address - Country:US
Mailing Address - Phone:512-339-6626
Mailing Address - Fax:512-425-3809
Practice Address - Street 1:12201 RENFERT WAY STE 225
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78758-5369
Practice Address - Country:US
Practice Address - Phone:512-339-6626
Practice Address - Fax:512-425-3809
Is Sole Proprietor?:No
Enumeration Date:2009-12-29
Last Update Date:2016-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA00021363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX345422501Medicaid