Provider Demographics
NPI:1598230245
Name:GILL, AMANDA HENSON (NP-C)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:HENSON
Last Name:GILL
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2080 S FRONTAGE RD STE 100
Mailing Address - Street 2:
Mailing Address - City:VICKSBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39180-5883
Mailing Address - Country:US
Mailing Address - Phone:601-262-1000
Mailing Address - Fax:601-630-9980
Practice Address - Street 1:2080 S FRONTAGE RD STE 100
Practice Address - Street 2:
Practice Address - City:VICKSBURG
Practice Address - State:MS
Practice Address - Zip Code:39180-5883
Practice Address - Country:US
Practice Address - Phone:601-262-1000
Practice Address - Fax:601-630-9980
Is Sole Proprietor?:No
Enumeration Date:2018-10-09
Last Update Date:2018-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS902974363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily