Provider Demographics
NPI:1851638829
Name:GAMBLIN, JENNIFER JUANITA (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:JUANITA
Last Name:GAMBLIN
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Gender:F
Credentials:PA-C
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Mailing Address - Street 1:1200 CHILDRENS AVE
Mailing Address - Street 2:SUITE 9500
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73104-4637
Mailing Address - Country:US
Mailing Address - Phone:405-271-6549
Mailing Address - Fax:405-271-7866
Practice Address - Street 1:1200 CHILDRENS AVE
Practice Address - Street 2:SUITE 9500
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73104-4637
Practice Address - Country:US
Practice Address - Phone:405-271-6549
Practice Address - Fax:405-271-7866
Is Sole Proprietor?:No
Enumeration Date:2013-01-11
Last Update Date:2013-01-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OKAPA2220363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant