Christopher Gully, NP
Individual provider Active NPI Gerontology Nurse Practitioner · Southaven, MS
NPI 1013778596 · NPPES record last updated Jun 24, 2024
Key facts
- NPI
- 1013778596
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Gerontology Nurse Practitioner 363LG0600X
- License
- 906487 (MS)
- Practice address
- 363 Southcrest Cir Ste 202
Southaven, MS 38671-4737 - Phone
- (901) 226-0456
- Fax
- (901) 226-0458
- NPI assigned
- Jan 22, 2024
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 9
Hospital & facility affiliations 1
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2023
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
- Mid-South Imaging and Therapeutics, P.a.
Practice addresses (Care Compare)
55 Physicians LN
Southaven, MS 38671-9569
Phone (901) 747-1007
7600 Wolf River Blvd
Suite 200
Germantown, TN 38138-1788
Phone (901) 747-1000
7601 Southcrest Pkwy
Southaven, MS 38671-4739
Phone (901) 383-9478
Hospital & facility affiliations
- Baptist Memorial Hospital Desoto
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in TN, MS
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240208000795 | TN | Practitioner - Nurse Practitioner | 6901249846 | Reassigns benefits to 2 organizations |
| I20240919003511 | MS | Practitioner - Nurse Practitioner | 6901249846 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3555 | TN | MD | Clinical Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mid-South Imaging & Therapeutics, P.a. | Current |
Accepting new patients | |
| Baptist Memorial Medical Group Inc | Current |
Accepting new patients | |
| Baptist Memorial Medical Group Inc | Current |
Accepting new patients | |
| Apex Vascular Outpatient Center | Past | Accepting new patients | |
| Baptist Memorial Health Services, Inc. of Mississippi | Past | Accepting new patients | |
| Adam Libby, DPM PLLC | Past |
Accepting new patients | |
| BMC - Attala, LLC | Past |
Accepting new patients | |
| Cassidy Bayou Medical Clinic | Past | Accepting new patients | |
| Medical Foundation of Central Mississippi, Inc. | Past |
Accepting new patients |
Locations (25 of 40)
100 Hospital St
Booneville, MS 38829
Phone (662) 720-5000
255 Baptist Blvd
Ste 301
Columbus, MS 39705
Phone (662) 244-2288
3102 Goodman Rd W
Horn Lake, MS 38637
Phone (662) 342-6676
702 Martin Luther King St
#702
Mound Bayou, MS 38762
363 Southcrest Cir
Ste 102
Southaven, MS 38671
Phone (662) 772-4615
7736 Airways Blvd
Southaven, MS 38671
Phone (662) 772-3700
363 Southcrest Cir
Ste 202
Southaven, MS 38671
Phone (662) 536-1944
55 Physicians Ln
Southaven, MS 38671
Phone (662) 655-2136
7601 Southcrest Pkwy
Southaven, MS 38671
Phone (662) 349-4000
75 Physicians Ln
Southaven, MS 38671
Phone (662) 393-7722
36 Capital Way
Ste E
Atoka, TN 38004
Phone (901) 837-6801
2545 N Washington Ave
Brownsville, TN 38012
Phone (731) 307-3777
1500 W Poplar Ave
Collierville, TN 38017
Phone (901) 227-8140
670 N Germantown Pkwy
Ste 18
Cordova, TN 38018
Phone (901) 753-7686
8138 Country Village Dr
Cordova, TN 38016
Phone (901) 725-8606
8000 Centerview Pkwy
Ste 101
Cordova, TN 38018
Phone (901) 624-2960
1995 Highway 51 S
Covington, TN 38019
Phone (901) 476-2621
801 S Meridian St
Greenfield, TN 38230
Phone (731) 235-0555
3493 Veterans Dr N
Ste C
Huntingdon, TN 38344
Phone (731) 668-4455
631 Rb Wilson Dr
Huntingdon, TN 38344
Phone (731) 986-2933
200 W Church St
Lexington, TN 38351
Phone (731) 968-1812
205C Hospital Dr
Mc Kenzie, TN 38201
Phone (731) 352-0820
589 Hwy 45E S
Medina, TN 38355
Phone (731) 235-0555
1400 S Germantown Rd
Memphis, TN 38138
Phone (901) 759-3111
8040 Wolf River Blvd
Ste 103
Memphis, TN 38138
Phone (901) 725-8606
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 3555 | TN | |
| Gerontology Nurse Practitioner | 363LG0600X | 906487 | MS | Yes |
Addresses
Primary practice location
363 Southcrest Cir Ste 202
Southaven, MS 38671-4737
Mailing address
965 Ridge Lake Blvd Ste 315
Memphis, TN 38120-9401
Phone (877) 348-1281
Other providers in Southaven, MS
- Sherikee Grim
- Courtney Grimes
- Leander M Grimm
- Olivia Marie Gruver
- Porfirio Guerrero Jr.
- Ratika Gunturi
- Kajijo M Guya
- Brian Douglas Haak
- Parker P Haberstroh
- Tristan Hadaway
All providers in Southaven, MS · Gerontology Nurse Practitioner in Mississippi
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 24, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.