Healthcare Provider Details

I. General information

NPI: 1619454857
Provider Name (Legal Business Name): SARAH KRISTEN GAMBLE NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2018
Last Update Date: 12/19/2023
Certification Date: 12/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7675 WELLNESS WAY
WEST CHESTER OH
45069-2509
US

IV. Provider business mailing address

PO BOX 636256
CINCINNATI OH
45263-6256
US

V. Phone/Fax

Practice location:
  • Phone: 513-475-7505
  • Fax: 513-475-8898
Mailing address:
  • Phone: 513-585-5506
  • Fax: 513-245-3672

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAPRN.CNP.023.128
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberAPRN.CNP.023128
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: