Healthcare Provider Details

I. General information

NPI: 1366616344
Provider Name (Legal Business Name): AMBER MARTIN ARNOLD NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/21/2008
Last Update Date: 10/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14116 CUSTOMS BLVD
GULFPORT MS
39503-5164
US

IV. Provider business mailing address

415 S 28TH AVE
HATTIESBURG MS
39401-7246
US

V. Phone/Fax

Practice location:
  • Phone: 601-957-6300
  • Fax:
Mailing address:
  • Phone: 601-296-2980
  • Fax: 601-579-5240

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number13403
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberA810661
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: