Provider Demographics
NPI:1912764747
Name:GAMBLE, KATELYN NICOLE (PA-C)
Entity Type:Individual
Prefix:MISS
First Name:KATELYN
Middle Name:NICOLE
Last Name:GAMBLE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2724 COUNTRY CLUB DR
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15205-8715
Mailing Address - Country:US
Mailing Address - Phone:412-780-6055
Mailing Address - Fax:
Practice Address - Street 1:651 HOLIDAY DR STE 100
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15220-2740
Practice Address - Country:US
Practice Address - Phone:412-922-8490
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-28
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA065047363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant