MEDICARE: AMY GRAY HANCOCK CFNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	R856115	MS

General Provider Information

NPI Number	:	1689896763
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY GRAY HANCOCK CFNP

Provider Business Mailing Address
First Line	:	7048 OLD CANTON RD STE 2E
Second Line	:
City	:	RIDGELAND
State	:	MS
Zip	:	39157-1021
Country	:	US
Telephone Number	:	601-992-9790
Fax Number	:	601-992-9796

Provider Business Practice Location Address
First Line	:	7048 OLD CANTON RD STE 2E
Second Line	:
City	:	RIDGELAND
State	:	MS
Zip	:	39157-1021
Country	:	US
Telephone Number	:	601-992-9790
Fax Number	:	601-992-9796

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/02/2007
Last Update Date	:	06/16/2025

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