Provider Demographics
NPI:1780789008
Name:MCALPINE, GWENDOLYN ADAMS (ANP)
Entity type:Individual
Prefix:MRS
First Name:GWENDOLYN
Middle Name:ADAMS
Last Name:MCALPINE
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1500 E WOODROW WILSON AVE # 586111
Mailing Address - Street 2:MEDICAL SERVICE
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39216-5116
Mailing Address - Country:US
Mailing Address - Phone:601-899-5980
Mailing Address - Fax:601-368-7502
Practice Address - Street 1:1500 E WOODROW WILSON AVE
Practice Address - Street 2:MEDICAL SERVICE
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-5116
Practice Address - Country:US
Practice Address - Phone:601-362-4471
Practice Address - Fax:601-367-7502
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2011-02-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LA64787363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health