Provider Demographics
NPI:1194700815
Name:GAMBLE, SYRENA DANETTE (CFA)
Entity type:Individual
Prefix:MRS
First Name:SYRENA
Middle Name:DANETTE
Last Name:GAMBLE
Suffix:
Gender:F
Credentials:CFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 MCGUIRE RD
Mailing Address - Street 2:
Mailing Address - City:SYMSONIA
Mailing Address - State:KY
Mailing Address - Zip Code:42082-9245
Mailing Address - Country:US
Mailing Address - Phone:270-519-7225
Mailing Address - Fax:
Practice Address - Street 1:625 MCGUIRE RD
Practice Address - Street 2:
Practice Address - City:SYMSONIA
Practice Address - State:KY
Practice Address - Zip Code:42082-9245
Practice Address - Country:US
Practice Address - Phone:270-519-7225
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY93154363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000376932Medicare UPIN