Healthcare Provider Details

I. General information

NPI: 1861990111
Provider Name (Legal Business Name): AMY MARIE GAMMEL FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2018
Last Update Date: 06/16/2021
Certification Date: 06/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 WOODLAND DR
WINONA MS
38967-1530
US

IV. Provider business mailing address

700 WOODLAND DR
WINONA MS
38967-1530
US

V. Phone/Fax

Practice location:
  • Phone: 662-283-3060
  • Fax:
Mailing address:
  • Phone: 662-283-3060
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number904698
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: