Provider Demographics
NPI:1013125160
Name:GAMBREL, MARY JEAN (MD, MS)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:JEAN
Last Name:GAMBREL
Suffix:
Gender:F
Credentials:MD, MS
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:JEAN
Other - Last Name:GAMBREL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD, MS
Mailing Address - Street 1:PO BOX 634
Mailing Address - Street 2:
Mailing Address - City:PINEVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40977-0634
Mailing Address - Country:US
Mailing Address - Phone:606-224-2591
Mailing Address - Fax:606-862-0142
Practice Address - Street 1:PO BOX 634
Practice Address - Street 2:
Practice Address - City:PINEVILLE
Practice Address - State:KY
Practice Address - Zip Code:40977-0634
Practice Address - Country:US
Practice Address - Phone:606-224-2591
Practice Address - Fax:606-654-2477
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2024-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY444822084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100156270Medicaid