Mary Gump Fly, ACNP

Primary specialty

Acute Care Nurse PractitionerTaxonomy code 363LA2100X

License

RN163789 Issued in GA

Practice address

1127 Druid Park Ave
Augusta, GA 30904-5849

Phone

(706) 364-6485

NPI assigned

Oct 11, 2006

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Miracle Making Ministries, Inc.

  • Public Health or Welfare Agency
  • Augusta, GA
  • NPI 1437259785
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1160524800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1629167580",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1231 GLENN AVE",
            "city": "AUGUSTA",
            "state": "GA",
            "postal_code": "309044615",
            "telephone_number": "706-736-1731"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1127 DRUID PARK AVE",
            "city": "AUGUSTA",
            "state": "GA",
            "postal_code": "309045849",
            "telephone_number": "706-364-6485"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FLY",
        "first_name": "MARY",
        "middle_name": "GUMP",
        "name_prefix": "Ms.",
        "credential": "ACNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-10-11",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "GA",
            "license": "RN163789",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tiffany Flournoy
• Brooklyn Flowers, APC
• David Thomas Floyd, M.D.
• Shontina Johnson Floyd, LCSW, CFSW, C-ASWCM
• Christopher A. Fly, MD
• Foci Rides 4 You
• Daniel Fogal, PHARMD
• Sumit Narayanprasad Fogla, M.D
• Jessie Nicole Foglio, DO
• Matthew Harrison Folan, DMD

• Acute Care Nurse Practitioner in Augusta, GA
• Providers in Augusta, GA by specialty
• Acute Care Nurse Practitioner in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.