Provider Demographics
NPI:1629201710
Name:GAMBLE, VICTORIA L (APN)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:L
Last Name:GAMBLE
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3644 W STATE HIGHWAY 18 STE B
Mailing Address - Street 2:
Mailing Address - City:MANILA
Mailing Address - State:AR
Mailing Address - Zip Code:72442-8049
Mailing Address - Country:US
Mailing Address - Phone:870-561-3300
Mailing Address - Fax:870-336-5321
Practice Address - Street 1:3644 W STATE HIGHWAY 18 STE B
Practice Address - Street 2:
Practice Address - City:MANILA
Practice Address - State:AR
Practice Address - Zip Code:72442-8049
Practice Address - Country:US
Practice Address - Phone:870-561-3300
Practice Address - Fax:870-561-3307
Is Sole Proprietor?:No
Enumeration Date:2009-08-24
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA003282363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR180058758Medicaid
AR57297Medicare PIN
AR180058758Medicaid