Provider Demographics
NPI:1265168785
Name:GAMBLE, KIMBERLY MICHELLE (HEALTH CARE PROVIDER)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:MICHELLE
Last Name:GAMBLE
Suffix:
Gender:F
Credentials:HEALTH CARE PROVIDER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2273 S BYRON BUTLER PKWY APT 6D
Mailing Address - Street 2:
Mailing Address - City:PERRY
Mailing Address - State:FL
Mailing Address - Zip Code:32348-6127
Mailing Address - Country:US
Mailing Address - Phone:850-672-3740
Mailing Address - Fax:
Practice Address - Street 1:2273 S BYRON BUTLER PKWY APT 6D
Practice Address - Street 2:
Practice Address - City:PERRY
Practice Address - State:FL
Practice Address - Zip Code:32348-6127
Practice Address - Country:US
Practice Address - Phone:850-672-3740
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-27
Last Update Date:2022-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL105719376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide