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General NPI Number Information
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NPI Number | 1013778596
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Entity Type | Individual
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Provider Name | CHRISTOPHER GULLY NP
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Gender | Male
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Dates
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Enumeration Date | 01/22/2024
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Last Update Date | 06/24/2024
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Provider Practice Location Address
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Address Line | 363 SOUTHCREST CIR STE 202
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City | SOUTHAVEN
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State | MS
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Zip | 38671-4737
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Country | US
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Telephone | 901-226-0456
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Fax | 901-226-0458
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Provider Business Mailing Address
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Address Line | 965 RIDGE LAKE BLVD STE 315
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City | MEMPHIS
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State | TN
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Zip | 38120-9401
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Country | US
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Telephone | 877-348-1281
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Fax | 901-227-3206
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 3555
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | 906487
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License Number State | MS
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