MEDICARE: GABRILLE ELAINE HAMILTON FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	0024027240	VA

General Provider Information

NPI Number	:	1114147428
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GABRILLE ELAINE HAMILTON FNP

Provider Business Mailing Address
First Line	:	105 W STONE DR
Second Line	:	SUITE 6A
City	:	KINGSPORT
State	:	TN
Zip	:	37660-3365
Country	:	US
Telephone Number	:	423-408-7220
Fax Number	:	423-408-7405

Provider Business Practice Location Address
First Line	:	127 HEALTH CARE DR
Second Line	:	SUITE 8
City	:	PENNINGTON GAP
State	:	VA
Zip	:	24277-2853
Country	:	US
Telephone Number	:	276-546-5212
Fax Number	:	276-546-1525

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/27/2007
Last Update Date	:	01/31/2013

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