Healthcare Provider Details

I. General information

NPI: 1033745047
Provider Name (Legal Business Name): FELISTIA NICOLE GAMBILL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: FELISTIA NICOLE CROWDER

II. Dates (important events)

Enumeration Date: 03/21/2020
Last Update Date: 08/19/2025
Certification Date: 08/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1817 W MORRIS BLVD
MORRISTOWN TN
37813-2837
US

IV. Provider business mailing address

1275 DICK LONAS RD UNIT 101
KNOXVILLE TN
37909-1383
US

V. Phone/Fax

Practice location:
  • Phone: 423-581-3904
  • Fax:
Mailing address:
  • Phone: 865-584-4747
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD482027
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number73129
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: