Elizabeth Ann Gamble, PSY.D.

Primary specialty

Clinical NeuropsychologistTaxonomy code 103G00000X

License

1853 Issued in NC

Practice address

2931 Breezewood Ave Ste 100
Fayetteville, NC 28303-5281

Phone

(910) 677-0000

Fax

(910) 677-0099

NPI assigned

Aug 9, 2005

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in NC

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 1991

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Fayetteville Neuropsychology PLLCGroup PAC ID 4385910686, 5 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Fayetteville Neuropsychology PLLC

  • Clinical Neuropsychologist
  • Fayetteville, NC
  • NPI 1053830315
  Medicare reassignment Care Compare group

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1123545600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1609977600000",
    "number": "1093716672",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2931 BREEZEWOOD AVE STE 100",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283035281",
            "telephone_number": "910-677-0000",
            "fax_number": "910-677-0099"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2931 BREEZEWOOD AVE STE 100",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283035281",
            "telephone_number": "910-677-0000",
            "fax_number": "910-677-0099"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1638 Owen Dr",
            "address_purpose": "LOCATION",
            "city": "Fayetteville",
            "state": "NC",
            "postal_code": "283043424",
            "country_code": "US",
            "telephone_number": "910-609-6440",
            "fax_number": "910-609-5365",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GAMBLE",
        "first_name": "ELIZABETH",
        "middle_name": "ANN",
        "name_prefix": "Miss",
        "credential": "PSY.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2005-08-09",
        "last_updated": "2021-01-07",
        "certification_date": "2021-01-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "NC",
            "license": "1853",
            "primary": false
        },
        {
            "code": "103G00000X",
            "taxonomy_group": "",
            "desc": "Clinical Neuropsychologist",
            "state": "NC",
            "license": "1853",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6000651",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2821711A",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jordan Galloway
• Resa B Galloway
• Amanda K Galvan, LCMHC, LPC
• Arryn Kasey Gamble, DPT
• Brian S Gamble, PHARMD
• Austin S Gamblin, MD
• Marc Gamboa, DPT
• Narendranath Reddy Ganampet
• James Michael Gannon, M.D.
• April Gant, MSN, FNP-BC

• Clinical Neuropsychologist in Fayetteville, NC
• Providers in Fayetteville, NC by specialty
• Clinical Neuropsychologist in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 7, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.