Healthcare Provider Details

I. General information

NPI: 1972109247
Provider Name (Legal Business Name): DEREK PAUL GAMBLE DNP, PMHNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/10/2020
Last Update Date: 09/24/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

WEED ARMY COMMUNITY HOSPITAL 390 NORTH LOOP ROAD
FORT IRWIN CA
92310
US

IV. Provider business mailing address

WEED ARMY COMMUNITY HOSPITAL 390 NORTH LOOP ROAD
FORT IRWIN CA
92310
US

V. Phone/Fax

Practice location:
  • Phone: 760-383-5440
  • Fax:
Mailing address:
  • Phone: 760-383-5440
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number27944
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: