Provider Demographics
NPI:1114453172
Name:GULLEDGE, CRYSTIN NASH (PA)
Entity Type:Individual
Prefix:
First Name:CRYSTIN
Middle Name:NASH
Last Name:GULLEDGE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:23951 VILLAGE CUT DR
Mailing Address - Street 2:
Mailing Address - City:ORANGE BEACH
Mailing Address - State:AL
Mailing Address - Zip Code:36561-5302
Mailing Address - Country:US
Mailing Address - Phone:678-793-5993
Mailing Address - Fax:
Practice Address - Street 1:1660 SPRING HILL AVE
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36604-1405
Practice Address - Country:US
Practice Address - Phone:251-665-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-11
Last Update Date:2020-09-11
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant