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NPI Code Detail

MEDICARE: GREGORY KEITH TICE NP-C

MEDICARE: GREGORY KEITH TICE NP-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse Practitioner1-074520AL

General Provider Information

NPI Number : 1700344488
Entity Type Code : Individual
Provider Name (Legal Business Name) : GREGORY KEITH TICE NP-C
Provider Business Mailing Address
First Line : 118 OBRANNAN PARK DR
Second Line :
City : DOTHAN
State : AL
Zip : 36303-2052
Country : US
Telephone Number : 334-305-2800
Fax Number : 866-554-1248
Provider Business Practice Location Address
First Line : 118 OBRANNAN PARK DR
Second Line :
City : DOTHAN
State : AL
Zip : 36303-2052
Country : US
Telephone Number : 334-305-2800
Fax Number : 866-554-1248
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/12/2019
Last Update Date : 03/29/2026

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