Provider Demographics
NPI:1639744295
Name:GAMBRELL, KENZEE KAY (PA)
Entity Type:Individual
Prefix:
First Name:KENZEE
Middle Name:KAY
Last Name:GAMBRELL
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:KENZEE
Other - Middle Name:KAY
Other - Last Name:PEETOOM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:1200 CHILDRENS AVE STE 11200
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73104-4637
Mailing Address - Country:US
Mailing Address - Phone:405-271-5656
Mailing Address - Fax:
Practice Address - Street 1:1200 CHILDRENS AVE STE 11200
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73104-4637
Practice Address - Country:US
Practice Address - Phone:405-271-5781
Practice Address - Fax:405-271-3919
Is Sole Proprietor?:No
Enumeration Date:2021-05-25
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK10001201OtherOBNDD
OK4636OtherSTATE
MG6745977OtherDEA