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General NPI Number Information
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NPI Number | 1730476367
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Entity Type | Individual
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Provider Name | KIRSTEN ROSETTA GAMBRELL M.D,
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Gender | Female
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Dates
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Enumeration Date | 07/04/2011
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Last Update Date | 01/03/2024
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Provider Practice Location Address
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Address Line | 2500 N STATE ST DEPARTMENT OF SURGERY
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City | JACKSON
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State | MS
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Zip | 39216-4500
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Country | US
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Telephone | 769-226-2525
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Fax |
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Provider Business Mailing Address
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Address Line | 1846 HOWARD ST
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City | JACKSON
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State | MS
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Zip | 39202-1325
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Country | US
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Telephone | 769-226-2525
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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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | T-2430
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License Number State | MS
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 70317
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License Number State | TN
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