Active NPI
Gary Dalton Gentry, APRN
- Nurse Practitioner
- Gulfport, MS
National Provider Identifier
1659477693
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse Practitioner
- License
- 607576
- Practice address
- 4500 13TH Street
Wound Care
Gulfport, MS 39501 - Phone
- (228) 867-4499
- Fax
- (228) 867-5027
- NPI assigned
- Sep 16, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | 607576 | MS | Primary |
Addresses
Primary practice location
4500 13TH Street
Wound Care
Gulfport, MS 39501
Mailing address
4500 13TH Street
Wound Care
Gulfport, MS 39501
Phone (228) 867-4499
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 05489238 | Medicaid | MS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158364800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1522886400000",
"number": "1659477693",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4500 13TH STREET",
"address_2": "WOUND CARE",
"city": "GULFPORT",
"state": "MS",
"postal_code": "39501",
"telephone_number": "228-867-4499",
"fax_number": "228-867-5027"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4500 13TH STREET",
"address_2": "WOUND CARE",
"city": "GULFPORT",
"state": "MS",
"postal_code": "39501",
"telephone_number": "228-867-4499",
"fax_number": "228-867-5027"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GENTRY",
"first_name": "GARY",
"middle_name": "DALTON",
"name_prefix": "Mr.",
"credential": "APRN",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-09-16",
"last_updated": "2018-04-05",
"status": "A"
},
"taxonomies": [
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "MS",
"license": "607576",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "05489238",
"state": "MS"
}
],
"endpoints": [],
"other_names": []
}Other providers in Gulfport, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 5, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.