Provider Demographics
NPI:1477650869
Name:OGIAMIEN, GLORIA A (CFNP)
Entity Type:Individual
Prefix:MS
First Name:GLORIA
Middle Name:A
Last Name:OGIAMIEN
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 370
Mailing Address - Street 2:
Mailing Address - City:TERRY
Mailing Address - State:MS
Mailing Address - Zip Code:39170-0370
Mailing Address - Country:US
Mailing Address - Phone:601-878-5115
Mailing Address - Fax:601-878-5164
Practice Address - Street 1:120 W. RAYMOND STREET
Practice Address - Street 2:
Practice Address - City:TERRY
Practice Address - State:MS
Practice Address - Zip Code:39170-0970
Practice Address - Country:US
Practice Address - Phone:601-878-5115
Practice Address - Fax:601-878-5164
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2022-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR831972363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00121280Medicaid
MS00121280Medicaid