MEDICARE: DR. AMERY JEAN CREIGHTON M.D.

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	207RN0300X	Nephrology Physician	19452	MS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1801893243
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AMERY JEAN CREIGHTON M.D.

Provider Business Mailing Address
First Line	:	4300B W RAILROAD ST
Second Line	:
City	:	GULFPORT
State	:	MS
Zip	:	39501-2568
Country	:	US
Telephone Number	:	228-863-7393
Fax Number	:	228-868-6643

Provider Business Practice Location Address
First Line	:	4300B W RAILROAD ST
Second Line	:
City	:	GULFPORT
State	:	MS
Zip	:	39501
Country	:	US
Telephone Number	:	228-863-7393
Fax Number	:	228-868-6643

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

Provider Enumeration Date	:	06/30/2005
Last Update Date	:	05/29/2018

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