Provider Demographics
NPI:1407625338
Name:GUGERT, PAULA RENE (DNP)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:RENE
Last Name:GUGERT
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7105 SWINNEA RD STE 1
Mailing Address - Street 2:
Mailing Address - City:SOUTHAVEN
Mailing Address - State:MS
Mailing Address - Zip Code:38671-6012
Mailing Address - Country:US
Mailing Address - Phone:901-767-0101
Mailing Address - Fax:
Practice Address - Street 1:300 S WALNUT BEND RD STE 12
Practice Address - Street 2:
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38018-7527
Practice Address - Country:US
Practice Address - Phone:901-767-0101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-20
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN35377363LA2100X
MS874413363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care