Healthcare Provider Details

I. General information

NPI: 1780789008
Provider Name (Legal Business Name): GWENDOLYN ADAMS MCALPINE ANP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2006
Last Update Date: 02/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 E WOODROW WILSON AVE MEDICAL SERVICE
JACKSON MS
39216-5116
US

IV. Provider business mailing address

1500 E WOODROW WILSON AVE # 586111 MEDICAL SERVICE
JACKSON MS
39216-5116
US

V. Phone/Fax

Practice location:
  • Phone: 601-362-4471
  • Fax: 601-367-7502
Mailing address:
  • Phone: 601-899-5980
  • Fax: 601-368-7502

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number64787
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: