Provider Demographics
NPI:1003282450
Name:GANN, AMANDA LOUANNE MILLS (APRN)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:LOUANNE MILLS
Last Name:GANN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MS
Other - First Name:AMANDA
Other - Middle Name:LOUANNE
Other - Last Name:MCGEORGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:121 W VIRGINIA AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:PINEVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40977-1600
Mailing Address - Country:US
Mailing Address - Phone:606-654-2412
Mailing Address - Fax:606-654-2519
Practice Address - Street 1:121 W VIRGINIA AVE
Practice Address - Street 2:
Practice Address - City:PINEVILLE
Practice Address - State:KY
Practice Address - Zip Code:40977-1661
Practice Address - Country:US
Practice Address - Phone:606-654-2412
Practice Address - Fax:606-654-2519
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-19
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3010059363LF0000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program