Individual
CODY RENALDO GULLICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
FNP-C
Contact information
Practice address
619 S STATE ST, CLARKSDALE, MS 38614-6319
(662) 812-1229
Mailing address
214 CEDAR HTS, POPE, MS 38658-2875
(662) 812-1229
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
902905
MS
Other
Enumeration date
09/12/2018
Last updated
09/12/2018
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