Provider Demographics
NPI:1932972064
Name:RICH, GABRIEL DAYLEN (PA-C)
Entity Type:Individual
Prefix:
First Name:GABRIEL
Middle Name:DAYLEN
Last Name:RICH
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 WHITE OAK RD STE 100
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:TN
Mailing Address - Zip Code:37321-2530
Mailing Address - Country:US
Mailing Address - Phone:423-599-0280
Mailing Address - Fax:
Practice Address - Street 1:144 BARTLETT CIR NE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37312-4734
Practice Address - Country:US
Practice Address - Phone:423-599-0280
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-31
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant