Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP2300X | Nurse Practitioner - Primary Care | 1-107147 | AL |
NPI | 1093039695 |
---|---|
Provider Name | Jamie Rose Ghrigsby |
First Address | Moulton, AL 35650-1221 |
Second Address | Moulton, AL 35650-1221 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/03/2010 |
Last Update Date | 21/02/2015 |