| Doctor Name: | MISS LONNELL GANT |
| NPI Number: | 1003937129 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | APRN |
| License Number: | 12628 |
| Business Practice Address: | 6063 Mt. Moriah Extd. Ste 4 Memphis, TN - 38118 |
| Business Phone Number: | 9015318800 |
| Business Fax Number: | |
| Mailing Address: | 4117 Parkchester Ave, MEMPHIS |
| State: | TN |
| Postal Code: | 381183923 |
| Phone Number: | 9013650796 |
| Fax Number: | |
| NPI Enumeration Date: | 04/03/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 12628 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TN |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |