Provider Demographics
NPI:1013171404
Name:THRAILKILL, GABRIELLE ROSE (LLM)
Entity type:Individual
Prefix:
First Name:GABRIELLE
Middle Name:ROSE
Last Name:THRAILKILL
Suffix:
Gender:F
Credentials:LLM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 W DEQUINCY AVE
Mailing Address - Street 2:
Mailing Address - City:DE QUEEN
Mailing Address - State:AR
Mailing Address - Zip Code:71832-2423
Mailing Address - Country:US
Mailing Address - Phone:870-642-5035
Mailing Address - Fax:
Practice Address - Street 1:315 W DEQUINCY AVE
Practice Address - Street 2:
Practice Address - City:DE QUEEN
Practice Address - State:AR
Practice Address - Zip Code:71832-2423
Practice Address - Country:US
Practice Address - Phone:870-642-5035
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-15
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR78711176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife