Provider Demographics
NPI:1083159099
Name:PONTIUS, AMY L (NP-C)
Entity type:Individual
Prefix:MS
First Name:AMY
Middle Name:L
Last Name:PONTIUS
Suffix:
Gender:F
Credentials:NP-C
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Mailing Address - Street 1:168 MOBILE INFIRMARY BLVD
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36607-3510
Mailing Address - Country:US
Mailing Address - Phone:251-433-1895
Mailing Address - Fax:251-433-1917
Practice Address - Street 1:15190 COMMUNITY RD STE 300
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39503-3499
Practice Address - Country:US
Practice Address - Phone:228-819-8586
Practice Address - Fax:228-831-3908
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-29
Last Update Date:2025-05-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MSR820497163W00000X
MS901897363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse