Individual
MR. GAVIN GILES GIST
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
APRN, ACNP-BC
Contact information
Practice address
100 BAPTIST MEMORIAL CIR STE 201, OXFORD, MS 38655-4476
(901) 271-1000
Mailing address
8060 WOLF RIVER BLVD, GERMANTOWN, TN 38138-1727
(901) 271-1000
(901) 271-4187
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
R862250
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
05752310
—
MS
Enumeration date
04/09/2008
Last updated
01/14/2021
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