MEDICARE: MOLLY GAMMELL APRN-CNP

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	1226407	TX
2	163W00000X	Registered Nurse	896151	TX

General Provider Information

NPI Number	:	1730592239
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MOLLY GAMMELL APRN-CNP

Provider Business Mailing Address
First Line	:	3625 LARIAT TRL
Second Line	:
City	:	VAN ALSTYNE
State	:	TX
Zip	:	75495-7152
Country	:	US
Telephone Number	:	714-457-6149
Fax Number	:

Provider Business Practice Location Address
First Line	:	3625 LARIAT TRL
Second Line	:
City	:	VAN ALSTYNE
State	:	TX
Zip	:	75495-7152
Country	:	US
Telephone Number	:	714-457-6149
Fax Number	:

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

Provider Enumeration Date	:	06/03/2014
Last Update Date	:	02/02/2026

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