MEDICARE: KERRY L GAMBLE 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	363LF0000X	Family Nurse Practitioner	95006721	CA
2	363LF0000X	Family Nurse Practitioner	AP61385648	WA

General Provider Information

NPI Number	:	1376064410
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KERRY L GAMBLE FNP

Provider Business Mailing Address
First Line	:	601 MCPHEE RD SW BLDG 1
Second Line	:
City	:	OLYMPIA
State	:	WA
Zip	:	98502-5080
Country	:	US
Telephone Number	:	564-669-5050
Fax Number	:	564-669-5055

Provider Business Practice Location Address
First Line	:	601 MCPHEE RD SW BLDG 1
Second Line	:
City	:	OLYMPIA
State	:	WA
Zip	:	98502-5080
Country	:	US
Telephone Number	:	564-669-5050
Fax Number	:

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

Provider Enumeration Date	:	06/29/2017
Last Update Date	:	02/04/2026

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