Christopher Gully, NP

Primary specialty

Gerontology Nurse PractitionerTaxonomy code 363LG0600X

License

906487 Issued in 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

Last updated

Jun 24, 2024By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in TN, MS2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 2

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.Group PAC ID 9133106396, 69 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Baptist Memorial Hospital Desoto Hospital, Southaven, MS, CCN 250141

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations (25 of 40)

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Mid-South Imaging & Therapeutics, P.a.

  • Diagnostic Radiology Physician
  • Germantown, TN
  • NPI 1043260763

  MS

  Medicare reassignment Care Compare group NPD
• Baptist Memorial Medical Group Inc

  • Internal Medicine Physician
  • Memphis, TN
  • NPI 1306089206

  MS

  Medicare reassignment NPD
• Baptist Memorial Medical Group Inc

  dba BMG East Memphis Pharmacy

  • Community/Retail Pharmacy
  • Memphis, TN
  • NPI 1841006129
  NPD
• BMC - Attala, LLC

  dba BMC Attala Kosciusko Primary Care

  • Rural Health Clinic/Center
  • Kosciusko, MS
  • NPI 1023481595
  NPD (past)
• Cassidy Bayou Medical Clinic

  • Family Medicine Physician
  • Sumner, MS
  • NPI 1376181990
  NPD (past)
• Medical Foundation of Central Mississippi, Inc.

  dba Baptist Medical Clinics

  • Internal Medicine Physician
  • Jackson, MS
  • NPI 1992774814
  NPD (past)
• Adam Libby, DPM PLLC

  • Podiatrist
  • Memphis, TN
  • NPI 1194593277
  NPD (past)
• Apex Vascular Outpatient Center

  • Ambulatory Surgical Clinic/Center
  • Lenoir City, TN
  • NPI 1467216457
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Baptist Memorial Hospital-Desoto, Inc,

  • General Acute Care Hospital
  • Southaven, MS
  • NPI 1194789818
  Care Compare affiliation

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1705881600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1719187200000",
    "number": "1013778596",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "965 RIDGE LAKE BLVD STE 315",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381209401",
            "telephone_number": "877-348-1281",
            "fax_number": "901-227-3206"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "363 SOUTHCREST CIR STE 202",
            "city": "SOUTHAVEN",
            "state": "MS",
            "postal_code": "386714737",
            "telephone_number": "901-226-0456",
            "fax_number": "901-226-0458"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GULLY",
        "first_name": "CHRISTOPHER",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-01-22",
        "last_updated": "2024-06-24",
        "certification_date": "2024-06-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TN",
            "license": "3555",
            "primary": false
        },
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "MS",
            "license": "906487",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sherikee Grim
• Courtney Grimes, COTA/L
• Leander M Grimm, M.D.
• Olivia Marie Gruver, DO
• Porfirio Guerrero Jr., PTA
• Ratika Gunturi, D.O
• Kajijo M Guya
• Brian Douglas Haak, CRNA
• Parker P Haberstroh
• Tristan Hadaway

• Gerontology Nurse Practitioner in Southaven, MS
• Providers in Southaven, MS by specialty
• Gerontology Nurse Practitioner in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.