Provider Demographics
NPI:1730821851
Name:GALE, TAMMY JO (MSN, FNP)
Entity type:Individual
Prefix:
First Name:TAMMY
Middle Name:JO
Last Name:GALE
Suffix:
Gender:F
Credentials:MSN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3702 JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:MOSS POINT
Mailing Address - State:MS
Mailing Address - Zip Code:39563-6218
Mailing Address - Country:US
Mailing Address - Phone:228-641-1674
Mailing Address - Fax:228-205-4593
Practice Address - Street 1:3702 JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:MOSS POINT
Practice Address - State:MS
Practice Address - Zip Code:39563-6218
Practice Address - Country:US
Practice Address - Phone:228-641-1674
Practice Address - Fax:228-205-4593
Is Sole Proprietor?:No
Enumeration Date:2022-04-09
Last Update Date:2025-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-117391363LF0000X
MS907153363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily