Provider Demographics
NPI:1871537332
Name:GUNN, JANICE (NP)
Entity type:Individual
Prefix:
First Name:JANICE
Middle Name:
Last Name:GUNN
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 1:4109 HWY 98 WEST
Mailing Address - Street 2:
Mailing Address - City:SUMMIT
Mailing Address - State:MS
Mailing Address - Zip Code:39666
Mailing Address - Country:US
Mailing Address - Phone:888-490-9107
Mailing Address - Fax:502-243-2225
Practice Address - Street 1:4109 HWY 98 WEST
Practice Address - Street 2:
Practice Address - City:SUMMIT
Practice Address - State:MS
Practice Address - Zip Code:39666
Practice Address - Country:US
Practice Address - Phone:888-490-9107
Practice Address - Fax:502-243-2225
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2016-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR718211363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS202011213AOtherBLUE CROSS
MS00116466Medicaid
MS202011213AOtherBLUE CROSS
MS500001762Medicare ID - Type Unspecified