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General NPI Number Information
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NPI Number | 1154156115
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Entity Type | Individual
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Provider Name | KATHLEEN GAMBILL CPNP-PC
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Gender | Female
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Dates
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Enumeration Date | 09/07/2024
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Last Update Date | 09/19/2024
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Provider Practice Location Address
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Address Line | 200 MARTIN LUTHER KING BLVD
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City | WICHITA FALLS
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State | TX
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Zip | 76301-1152
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Country | US
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Telephone | 940-766-6306
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Fax |
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Provider Business Mailing Address
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Address Line | 5306 RIVIERA DR
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City | WICHITA FALLS
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State | TX
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Zip | 76310-3033
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Country | US
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Telephone | 940-232-0087
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 1171636
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | 1171636
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License Number State | TX
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