Healthcare Provider Details

I. General information

NPI: 1114453172
Provider Name (Legal Business Name): CRYSTIN NASH GULLEDGE P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2017
Last Update Date: 09/11/2020
Certification Date: 09/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1660 SPRING HILL AVE
MOBILE AL
36604-1405
US

IV. Provider business mailing address

23951 VILLAGE CUT DR
ORANGE BEACH AL
36561-5302
US

V. Phone/Fax

Practice location:
  • Phone: 251-665-8000
  • Fax:
Mailing address:
  • Phone: 678-793-5993
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: