Healthcare Provider Details

I. General information

NPI: 1609689140
Provider Name (Legal Business Name): HUNTER TILLERY GELSTON FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2025
Last Update Date: 01/29/2025
Certification Date: 01/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

709 CLINIC PKWAY
CLINTON MS
39056
US

IV. Provider business mailing address

106 HAMPTON TRL
MADISON MS
39110-6670
US

V. Phone/Fax

Practice location:
  • Phone: 601-709-1130
  • Fax:
Mailing address:
  • Phone: 601-955-7291
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number907115
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: