Individual
MS. MARY ALYSSA GILLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
56 DUTCH LN, COLUMBUS, MS 39702-5500
(662) 329-3808
(662) 329-3873
Mailing address
56 DUTCH LN, COLUMBUS, MS 39702-5500
(662) 329-3808
(662) 329-3873
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
902060
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
07121209
—
MS
Enumeration date
06/02/2016
Last updated
01/28/2019
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