Healthcare Provider Details

I. General information

NPI: 1871537332
Provider Name (Legal Business Name): JANICE GUNN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 04/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4109 HWY 98 WEST
SUMMIT MS
39666
US

IV. Provider business mailing address

4109 HWY 98 WEST
SUMMIT MS
39666
US

V. Phone/Fax

Practice location:
  • Phone: 888-490-9107
  • Fax: 502-243-2225
Mailing address:
  • Phone: 888-490-9107
  • Fax: 502-243-2225

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR718211
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: