Provider Demographics
NPI:1730343393
Name:GAMBINO, KIMBERLY R (APRN)
Entity type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:R
Last Name:GAMBINO
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3647 FALLING SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:BONNIEVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42713-7407
Mailing Address - Country:US
Mailing Address - Phone:270-524-7939
Mailing Address - Fax:877-395-1445
Practice Address - Street 1:103 E SOUTH ST
Practice Address - Street 2:
Practice Address - City:MUNFORDVILLE
Practice Address - State:KY
Practice Address - Zip Code:42765-9023
Practice Address - Country:US
Practice Address - Phone:270-524-7939
Practice Address - Fax:877-395-1445
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-14
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3005702363L00000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY3005702OtherLICENSE