Provider Demographics
NPI:1033723093
Name:RYALS, AMBER (NP)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:
Last Name:RYALS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 HARDY ST STE 30
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39401-5928
Mailing Address - Country:US
Mailing Address - Phone:601-318-0669
Mailing Address - Fax:601-620-4302
Practice Address - Street 1:2200 HARDY ST STE 30
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39401-5928
Practice Address - Country:US
Practice Address - Phone:601-318-0669
Practice Address - Fax:601-620-4302
Is Sole Proprietor?:No
Enumeration Date:2020-09-06
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS895981163WE0003X
MS904441363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WE0003XNursing Service ProvidersRegistered NurseEmergency
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS04788071Medicaid