Healthcare Provider Details

I. General information

NPI: 1730343393
Provider Name (Legal Business Name): KIMBERLY R GAMBINO APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2008
Last Update Date: 06/20/2023
Certification Date: 06/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 E SOUTH ST
MUNFORDVILLE KY
42765-9023
US

IV. Provider business mailing address

3647 FALLING SPRINGS RD
BONNIEVILLE KY
42713-7407
US

V. Phone/Fax

Practice location:
  • Phone: 270-524-7939
  • Fax: 877-395-1445
Mailing address:
  • Phone: 270-524-7939
  • Fax: 877-395-1445

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number3005702
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number3005702
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: