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NPI Code Detail

MEDICARE: MRS. KRISTIE KAY GAMBLE CRNA

MEDICARE: MRS. KRISTIE KAY GAMBLE CRNA
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
1367500000XCertified Registered Nurse Anesthetist3001377KY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1000000201261OTHERKYANTHEM BCBS- BAPTIST HEALTH
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1407822729
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. KRISTIE KAY GAMBLE CRNA
Provider Business Mailing Address
First Line : 200 CLINIC DR
Second Line :
City : MADISONVILLE
State : KY
Zip : 42431-1661
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 900 HOSPITAL DR
Second Line :
City : MADISONVILLE
State : KY
Zip : 42431-1644
Country : US
Telephone Number : 270-825-5100
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/27/2006
Last Update Date : 01/08/2015

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