Individual
GAMBRELL MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4271 CYPRESS DR # 42, JACKSON, MS 39212-3406
(601) 983-6016
Mailing address
4271 CYPRESS DR # 42, JACKSON, MS 39212-3406
(601) 983-6016
Taxonomy
Speciality
Code
Description
License number
State
374U00000X
Home Health Aide
Primary
800753572
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
861625652
—
MS
Enumeration date
03/19/2021
Last updated
03/19/2021
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