Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 3010059 | KY |
NPI | 1003282450 |
---|---|
Provider Name | Amanda Louanne Mills Gann |
First Address | Pineville, KY 40977-9253 |
Second Address | Pineville, KY 40977-1452 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/08/2015 |
Last Update Date | 12/02/2021 |