Provider Demographics
NPI:1851123160
Name:PROCTOR, GABREYEL NY'ASIA
Entity type:Individual
Prefix:
First Name:GABREYEL
Middle Name:NY'ASIA
Last Name:PROCTOR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:144 BARATARA DR
Mailing Address - Street 2:
Mailing Address - City:CHICKASAW
Mailing Address - State:AL
Mailing Address - Zip Code:36611-1100
Mailing Address - Country:US
Mailing Address - Phone:251-307-7952
Mailing Address - Fax:
Practice Address - Street 1:4000 DAUPHIN ST
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36608-1780
Practice Address - Country:US
Practice Address - Phone:251-380-4000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-15
Last Update Date:2024-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program