Healthcare Provider Details

I. General information

NPI: 1952219990
Provider Name (Legal Business Name): MARTHA GAIL PRIEST FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARNIE GAIL PRIEST FNP-BC

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 MAIN ST S
AMORY MS
38821-4221
US

IV. Provider business mailing address

144 MORGAN CIR
NETTLETON MS
38858-6023
US

V. Phone/Fax

Practice location:
  • Phone: 662-305-5361
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number908749
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: