Provider Demographics
NPI:1659679967
Name:GABLE, KAROLYN SHIRLEY (NP)
Entity Type:Individual
Prefix:MRS
First Name:KAROLYN
Middle Name:SHIRLEY
Last Name:GABLE
Suffix:
Gender:F
Credentials:NP
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Mailing Address - Street 1:850 W RIO SALADO PKWY STE 201
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85281-3812
Mailing Address - Country:US
Mailing Address - Phone:480-480-8330
Mailing Address - Fax:
Practice Address - Street 1:1004 SUSHRUTA DR STE A
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25401-8801
Practice Address - Country:US
Practice Address - Phone:304-449-3778
Practice Address - Fax:304-449-3777
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-10
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024169261363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1659679967Medicaid
WV1659679967Medicaid