Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | R863420 | MS |
Y | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | 863420 | MS |
NPI | 1124218490 |
---|---|
Provider Name | Mrs. Amy K O'mara |
First Address | Jackson, MS 39216-4500 |
Second Address | Jackson, MS 39216-4500 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/08/2007 |
Last Update Date | 22/05/2017 |