NPI Code Detail JSON Logo

1730476367 NPI number — KIRSTEN ROSETTA GAMBRELL M.D,

NPI Number: 1730476367
Health Care Provider/Practitioner: KIRSTEN ROSETTA GAMBRELL M.D,

Information about “1730476367” NPI (KIRSTEN ROSETTA GAMBRELL M.D,) exists in 1730476367 in HTML format HTML  |  1730476367 in plain Text format TXT  |  1730476367 in PDF (Portable Document Format) PDF  |  1730476367 in an XML format XML  formats.

NPI Number : 1730476367 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1730476367",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "GAMBRELL",
    "FirstName": "KIRSTEN",
    "MiddleName": "ROSETTA",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "M.D,",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "1846 HOWARD ST",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "JACKSON",
    "MailingAddressStateName": "MS",
    "MailingAddressPostalCode": "39202-1325",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "769-226-2525",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "2500 N STATE ST",
    "SecondLinePracticeLocationAddress": "DEPARTMENT OF SURGERY",
    "PracticeLocationAddressCityName": "JACKSON",
    "PracticeLocationAddressStateName": "MS",
    "PracticeLocationAddressPostalCode": "39216-4500",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "769-226-2525",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "07/04/2011",
    "LastUpdateDate": "01/03/2024",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "208600000X",
          "TaxonomyName": "Surgery Physician",
          "LicenseNumber": "T-2430",
          "LicenseNumberStateCode": "MS",
          "PrimaryTaxonomySwitch": "Y"
        },
        {
          "TaxonomyCode": "208600000X",
          "TaxonomyName": "Surgery Physician",
          "LicenseNumber": "70317",
          "LicenseNumberStateCode": "TN",
          "PrimaryTaxonomySwitch": "N"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

Copyright © 2007-2026 Data Labs Health. All rights reserved.