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General NPI Number Information
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NPI Number | 1417511973
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Entity Type | Organization
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Legal Business Name | KIMBERLY GAMBINO LLC
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Dates
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Enumeration Date | 04/30/2019
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Last Update Date | 03/16/2023
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Provider Practice Location Address
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Address Line | 103 E SOUTH ST
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City | MUNFORDVILLE
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State | KY
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Zip | 42765-9023
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Country | US
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Telephone | 270-524-7939
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Fax | 877-395-1445
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Provider Business Mailing Address
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Address Line | PO BOX 657
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City | MUNFORDVILLE
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State | KY
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Zip | 42765-0657
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Country | US
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Telephone | 270-505-3835
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MR. JAMES VINCENT GAMBINO III
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Credential |
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Telephone | 270-505-3835
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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