Healthcare Provider Details

I. General information

NPI: 1477650869
Provider Name (Legal Business Name): GLORIA A OGIAMIEN CFNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 BRIARWOOD DR STE 305-A
JACKSON MS
39206-3052
US

IV. Provider business mailing address

405 BRIARWOOD DR STE 305-A
JACKSON MS
39206-3052
US

V. Phone/Fax

Practice location:
  • Phone: 601-326-7614
  • Fax: 601-326-7616
Mailing address:
  • Phone: 601-326-7614
  • Fax: 601-326-7616

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR831972
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: