Provider Demographics
NPI:1205910692
Name:KIMBALL, GAIL KEY (APRN, A/GNP-C)
Entity type:Individual
Prefix:
First Name:GAIL
Middle Name:KEY
Last Name:KIMBALL
Suffix:
Gender:F
Credentials:APRN, A/GNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 N SALISBURY AVE
Mailing Address - Street 2:
Mailing Address - City:SPENCER
Mailing Address - State:NC
Mailing Address - Zip Code:28159-2514
Mailing Address - Country:US
Mailing Address - Phone:704-633-7070
Mailing Address - Fax:704-633-7627
Practice Address - Street 1:300 N SALISBURY AVE
Practice Address - Street 2:
Practice Address - City:SPENCER
Practice Address - State:NC
Practice Address - Zip Code:28159-2514
Practice Address - Country:US
Practice Address - Phone:704-633-7070
Practice Address - Fax:704-633-7627
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC600037363LA2200X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Not Answered363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC600037OtherNC LICENSE NUMBE
NCMK1371246OtherDEA NUMBER
NC600037OtherNC LICENSE NUMBE
NCP00302094Medicare ID - Type UnspecifiedRAILROAD MEDICARE
NCCL2573Medicare ID - Type UnspecifiedRAILROAD MEDICARE GROUP #
NCMK1371246OtherDEA NUMBER