Provider Demographics
NPI:1831705565
Name:GULLICK, EMALEE (NP)
Entity type:Individual
Prefix:
First Name:EMALEE
Middle Name:
Last Name:GULLICK
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:499 S GLOSTER ST # G1
Mailing Address - Street 2:
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38801-5539
Mailing Address - Country:US
Mailing Address - Phone:662-377-2663
Mailing Address - Fax:
Practice Address - Street 1:499 S GLOSTER ST # G1
Practice Address - Street 2:
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38801-5539
Practice Address - Country:US
Practice Address - Phone:662-377-2663
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-17
Last Update Date:2022-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS903976363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily