Healthcare Provider Details

I. General information

NPI: 1326951484
Provider Name (Legal Business Name): GARI ASHLI BROOKE LYLE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1105 EARL FRYE BLVD
AMORY MS
38821-5500
US

IV. Provider business mailing address

112 PECAN ORCHARD LN
AMORY MS
38821-2613
US

V. Phone/Fax

Practice location:
  • Phone: 662-315-0011
  • Fax:
Mailing address:
  • Phone: 662-315-0011
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number912788
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: