Provider Demographics
NPI:1689896763
Name:HANCOCK, AMY GRAY (CFNP)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:GRAY
Last Name:HANCOCK
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7048 OLD CANTON RD STE 2E
Mailing Address - Street 2:
Mailing Address - City:RIDGELAND
Mailing Address - State:MS
Mailing Address - Zip Code:39157-1021
Mailing Address - Country:US
Mailing Address - Phone:601-992-9790
Mailing Address - Fax:601-992-9796
Practice Address - Street 1:7048 OLD CANTON RD STE 2E
Practice Address - Street 2:
Practice Address - City:RIDGELAND
Practice Address - State:MS
Practice Address - Zip Code:39157-1021
Practice Address - Country:US
Practice Address - Phone:601-992-9790
Practice Address - Fax:601-992-9796
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2025-06-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MSR856115363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
T26879Medicare UPIN