Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | 24843 | SC |
NPI | 1023683745 |
---|---|
Provider Name | Amy Lynn Gregory |
First Address | Rogersville, MO 65742-7228 |
Second Address | Matthews, NC 28105-5374 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/05/2021 |
Last Update Date | 25/05/2021 |