Provider Demographics
NPI:1740288349
Name:GULISH, KRISTOPHER EUGENE (PA)
Entity type:Individual
Prefix:MR
First Name:KRISTOPHER
Middle Name:EUGENE
Last Name:GULISH
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1015 KELLEY DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PARIS
Mailing Address - State:TN
Mailing Address - Zip Code:38242-5819
Mailing Address - Country:US
Mailing Address - Phone:731-644-2271
Mailing Address - Fax:731-644-3980
Practice Address - Street 1:1015 KELLEY DR
Practice Address - Street 2:SUITE 200
Practice Address - City:PARIS
Practice Address - State:TN
Practice Address - Zip Code:38242-5819
Practice Address - Country:US
Practice Address - Phone:731-644-2271
Practice Address - Fax:731-644-3980
Is Sole Proprietor?:No
Enumeration Date:2005-07-08
Last Update Date:2013-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1164363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3662542Medicaid
TN1124048541OtherGROUP NPI
TN1740288349OtherNPI
TN4090494OtherBCBSTN
TN4090498OtherBCBSTN
TN4090494OtherBCBSTN
TNP00154788Medicare ID - Type UnspecifiedTRAVELERS MEDICARE
TNQ21603Medicare UPIN
TN3662542Medicaid
TN1124048541OtherGROUP NPI