MEDICARE: ALEXIS GUMBLE PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant

General Provider Information

NPI Number	:	1659106185
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEXIS GUMBLE PA-C

Provider Business Mailing Address
First Line	:	PO BOX 201
Second Line	:
City	:	TAFTON
State	:	PA
Zip	:	18464-0201
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1420 BEVERLY RD
Second Line	:
City	:	MC LEAN
State	:	VA
Zip	:	22101-3732
Country	:	US
Telephone Number	:	877-772-6505
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/04/2024
Last Update Date	:	09/04/2024

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Directions to “ ALEXIS GUMBLE PA-C” Practice Location

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