MEDICARE: JANICE GUNN NP

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	363L00000X	Nurse Practitioner	R718211	MS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	202011213A	OTHER	MS	BLUE CROSS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1871537332
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANICE GUNN NP

Provider Business Mailing Address
First Line	:	4109 HWY 98 WEST
Second Line	:
City	:	SUMMIT
State	:	MS
Zip	:	39666
Country	:	US
Telephone Number	:	888-490-9107
Fax Number	:	502-243-2225

Provider Business Practice Location Address
First Line	:	4109 HWY 98 WEST
Second Line	:
City	:	SUMMIT
State	:	MS
Zip	:	39666
Country	:	US
Telephone Number	:	888-490-9107
Fax Number	:	502-243-2225

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

Provider Enumeration Date	:	06/15/2006
Last Update Date	:	04/06/2016

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Directions to “ JANICE GUNN NP” Practice Location

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