Provider Demographics
NPI:1144334863
Name:GAMBILL, MARIBETH (APN)
Entity type:Individual
Prefix:
First Name:MARIBETH
Middle Name:
Last Name:GAMBILL
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 293
Mailing Address - Street 2:
Mailing Address - City:BASTROP
Mailing Address - State:LA
Mailing Address - Zip Code:71221-0293
Mailing Address - Country:US
Mailing Address - Phone:318-283-3920
Mailing Address - Fax:318-239-8920
Practice Address - Street 1:616 S WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:BASTROP
Practice Address - State:LA
Practice Address - Zip Code:71220-5035
Practice Address - Country:US
Practice Address - Phone:318-283-3990
Practice Address - Fax:318-239-8990
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2023-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA001549363LF0000X
LAAP08704363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2411861Medicaid
ARP29171Medicare UPIN
AR142880758Medicaid