Provider Demographics
NPI:1184737678
Name:GAMBILL, CHRISTY LIANNE (PA-C)
Entity type:Individual
Prefix:MISS
First Name:CHRISTY
Middle Name:LIANNE
Last Name:GAMBILL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:445 COMMONWEALTH BLVD E
Mailing Address - Street 2:
Mailing Address - City:MARTINSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24112-2014
Mailing Address - Country:US
Mailing Address - Phone:276-632-3841
Mailing Address - Fax:276-632-2437
Practice Address - Street 1:445 COMMONWEALTH BLVD E
Practice Address - Street 2:
Practice Address - City:MARTINSVILLE
Practice Address - State:VA
Practice Address - Zip Code:24112-2014
Practice Address - Country:US
Practice Address - Phone:276-632-3841
Practice Address - Fax:276-632-2437
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2017-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110002175363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAQ65675Medicare UPIN
VAQ65675Medicare UPIN