Cody Renaldo Gullick, FNP-C

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

902905 Issued in MS

Practice address

619 S State St
Clarksdale, MS 38614-6319

Phone

(662) 812-1229

NPI assigned

Sep 12, 2018

Last updated

Sep 12, 2018By 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 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MS

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 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

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.

• Cary N Mettetal

  dba Mettetal Family Medicine

  • Family Medicine Physician
  • Sardis, MS
  • NPI 1083786727
  Medicare reassignment NPD
• Family First Clinic of Clarksdale, PLLC

  • Family Medicine Physician
  • Clarksdale, MS
  • NPI 1215206016
  Medicare reassignment NPD
• Fast Pace Mississippi, PLLC

  • Rural Health Clinic/Center
  • Ripley, MS
  • NPI 1447769559

  Family

  Medicare reassignment NPD
• Fast Pace Mississippi, PLLC

  • Rural Health Clinic/Center
  • Kosciusko, MS
  • NPI 1851050579
  NPD

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

{
    "created_epoch": "1536710400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1536710400000",
    "number": "1205319530",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "214 CEDAR HTS",
            "city": "POPE",
            "state": "MS",
            "postal_code": "386582875",
            "telephone_number": "662-812-1229"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "619 S STATE ST",
            "city": "CLARKSDALE",
            "state": "MS",
            "postal_code": "386146319",
            "telephone_number": "662-812-1229"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GULLICK",
        "first_name": "CODY",
        "middle_name": "RENALDO",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-09-12",
        "last_updated": "2018-09-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MS",
            "license": "902905",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alecia Greer, CNA
• Frances Parker Griffin, MSW
• Regina Denise Groner, NURSE PRACTITIONER
• Guardian Angel Adult Day Services LLC
• Meghann E Gulledge Yee, M.ED.
• Mohamad F Hadidi, M.D.
• Undra L Haggan, NURSE PRACTITIONER
• Haggard Drug Store Inc.
• Clifford Hall, M.D.
• Alvin Ray Hamilton Jr., CRNA

• Family Nurse Practitioner in Clarksdale, MS
• Providers in Clarksdale, MS by specialty
• Family Nurse Practitioner in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 2018; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.