1255308292 NPI number — VIKKI L GAMBRILL CRNA

Table of content: VIKKI L GAMBRILL CRNA (NPI 1255308292)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255308292 NPI number — VIKKI L GAMBRILL CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GAMBRILL
Provider First Name:
VIKKI
Provider Middle Name:
L
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CRNA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DILLARD
Provider Other First Name:
VIKKI
Provider Other Middle Name:
L
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
RN, CRNA
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1255308292
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/29/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 269
Provider Second Line Business Mailing Address:
GPMS C/O INTERVENTIONAL PAIN GROUP
Provider Business Mailing Address City Name:
LANSING
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
66043-0269
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
913-828-0136
Provider Business Mailing Address Fax Number:
913-828-0296

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1004 PROGRESS DR
Provider Second Line Business Practice Location Address:
STE 170
Provider Business Practice Location Address City Name:
LANSING
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66043-6323
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-828-0136
Provider Business Practice Location Address Fax Number:
913-828-0296
Provider Enumeration Date:
03/08/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 163W00000X , with the licence number:  2001008908 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 163W00000X , with the licence number: 1373885015 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 163W00000X , with the licence number: 55066 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 163WP0000X , with the licence number: 55066 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 367500000X , with the licence number: 2001008908 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 367500000X , with the licence number: 55066 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)