Healthcare Provider Details

I. General information

NPI: 1730821851
Provider Name (Legal Business Name): TAMMY JO GALE MSN, FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2022
Last Update Date: 07/03/2026
Certification Date: 07/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3702 JEFFERSON AVE
MOSS POINT MS
39563-6218
US

IV. Provider business mailing address

3702 JEFFERSON AVE
MOSS POINT MS
39563-6218
US

V. Phone/Fax

Practice location:
  • Phone: 228-641-1674
  • Fax: 228-250-1132
Mailing address:
  • Phone: 228-641-1674
  • Fax: 228-205-4593

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number907153
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1-117391
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: