Healthcare Provider Details

I. General information

NPI: 1659679967
Provider Name (Legal Business Name): KAROLYN SHIRLEY GABLE N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/10/2011
Last Update Date: 07/06/2023
Certification Date: 07/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1004 SUSHRUTA DR STE A
MARTINSBURG WV
25401-8801
US

IV. Provider business mailing address

850 W RIO SALADO PKWY STE 201
TEMPE AZ
85281-3812
US

V. Phone/Fax

Practice location:
  • Phone: 304-449-3778
  • Fax: 304-449-3777
Mailing address:
  • Phone: 480-480-8330
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number0024169261
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: