Basic Information
| Provider Information | |||||||||
| NPI: | 1447508320 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GIPSON | ||||||||
| FirstName: | AMY | ||||||||
| MiddleName: | DANAE | ||||||||
| NamePrefix: | MISS | ||||||||
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| Credential: | FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4508 JAMAICA PL | ||||||||
| Address2: | |||||||||
| City: | JONESBORO | ||||||||
| State: | AR | ||||||||
| PostalCode: | 724011929 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5019403038 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 201 E OAK AVE | ||||||||
| Address2: | |||||||||
| City: | JONESBORO | ||||||||
| State: | AR | ||||||||
| PostalCode: | 724014163 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8709356729 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/26/2012 | ||||||||
| LastUpdateDate: | 04/23/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | A003759 | AR | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.