Individual
LISA BOYER GATWOOD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
5192 OLD HIGHWAY 11, HATTIESBURG, MS 39402-6222
(601) 268-0929
(601) 261-0508
Mailing address
415 S 28TH AVE, HATTIESBURG, MS 39401-7246
(601) 268-0929
(601) 579-5240
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
R855762
MS
363LF0000X
Family Nurse Practitioner
Primary
855762
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02123058
—
MS
Enumeration date
10/13/2008
Last updated
08/11/2020
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