MEDICARE: MRS. REAH GAMBRELL PMH-NP

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	1007022	TX

General Provider Information

NPI Number	:	1144830597
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. REAH GAMBRELL PMH-NP

Provider Business Mailing Address
First Line	:	1410 8TH ST
Second Line	:
City	:	WICHITA FALLS
State	:	TX
Zip	:	76301-3105
Country	:	US
Telephone Number	:	940-264-8818
Fax Number	:	940-264-8819

Provider Business Practice Location Address
First Line	:	1410 8TH ST
Second Line	:
City	:	WICHITA FALLS
State	:	TX
Zip	:	76301-3105
Country	:	US
Telephone Number	:	940-264-8818
Fax Number	:	940-264-8819

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

Provider Enumeration Date	:	07/31/2020
Last Update Date	:	06/27/2025

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