Provider Demographics
NPI:1639522196
Name:MCLEOD, GENNITHA MARIE (FNP)
Entity type:Individual
Prefix:MRS
First Name:GENNITHA
Middle Name:MARIE
Last Name:MCLEOD
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MRS
Other - First Name:GENNITHA
Other - Middle Name:MARIE
Other - Last Name:JACKSON RICE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:30 HOLMES DRIVE
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:AL
Mailing Address - Zip Code:36203
Mailing Address - Country:US
Mailing Address - Phone:256-403-3534
Mailing Address - Fax:256-403-3541
Practice Address - Street 1:30 HOLMES DRIVE
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:AL
Practice Address - Zip Code:36203
Practice Address - Country:US
Practice Address - Phone:256-403-3534
Practice Address - Fax:256-403-3541
Is Sole Proprietor?:No
Enumeration Date:2016-07-20
Last Update Date:2021-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN237968363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003178587AMedicaid
GA202503I184OtherMEDICARE PTAN