Healthcare Provider Details

I. General information

NPI: 1841110079
Provider Name (Legal Business Name): AMY SKINNER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2026
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1203 BROAD AVE
GULFPORT MS
39501-2489
US

IV. Provider business mailing address

1203 BROAD AVE
GULFPORT MS
39501-2489
US

V. Phone/Fax

Practice location:
  • Phone: 228-868-5555
  • Fax:
Mailing address:
  • Phone: 228-868-5555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number908481
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: