Healthcare Provider Details

I. General information

NPI: 1780607671
Provider Name (Legal Business Name): KIMBERLY GAGE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 10/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

511 E COLUMBUS AVE
SPRINGFIELD MA
01105-2506
US

IV. Provider business mailing address

511 E COLUMBUS AVE
SPRINGFIELD MA
01105-2506
US

V. Phone/Fax

Practice location:
  • Phone: 413-827-8959
  • Fax: 413-827-7015
Mailing address:
  • Phone: 413-827-8959
  • Fax: 413-827-7015

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number183097
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License Number183097
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number183097
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: