Provider Demographics
NPI:1801893243
Name:CREIGHTON, AMERY JEAN (MD)
Entity type:Individual
Prefix:DR
First Name:AMERY
Middle Name:JEAN
Last Name:CREIGHTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:4300B W RAILROAD ST
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39501-2568
Mailing Address - Country:US
Mailing Address - Phone:228-863-7393
Mailing Address - Fax:228-868-6643
Practice Address - Street 1:4300B W RAILROAD ST
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39501
Practice Address - Country:US
Practice Address - Phone:228-863-7393
Practice Address - Fax:228-868-6643
Is Sole Proprietor?:No
Enumeration Date:2005-06-30
Last Update Date:2018-05-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MS19452207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS02423720Medicaid
302G700865Medicare PIN
MSC02221Medicare PIN
P00342755Medicare PIN
MS390000159Medicare PIN
MSG81459Medicare UPIN