Basic Information
| Provider Information | |||||||||
| NPI: | 1609950054 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GIST | ||||||||
| FirstName: | BETH | ||||||||
| MiddleName: | ANN | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MSN, CNM, WHCNP, APN | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | HUDSON | ||||||||
| OtherFirstName: | BETH | ||||||||
| OtherMiddleName: | ANN | ||||||||
| OtherNamePrefix: | MS. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | MSN, CNM, WHCPN, APN | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | PO BOX 1178 | ||||||||
| Address2: | |||||||||
| City: | PULASKI | ||||||||
| State: | TN | ||||||||
| PostalCode: | 384781178 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9312078668 | ||||||||
| FaxNumber: | 9313633939 | ||||||||
| Practice Location | |||||||||
| Address1: | 2611 W END AVE | ||||||||
| Address2: | SUITE 380 | ||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 372036013 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6159365858 | ||||||||
| FaxNumber: | 6159362600 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/24/2006 | ||||||||
| LastUpdateDate: | 11/19/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LW0102X | APN0000012186 | TN | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Women's Health | 367A00000X | APN0000012186 | TN | Y | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife | 367A00000X | 09000116A | IN | N | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife |
ID Information
| ID | Type | State | Issuer | Description | 01226610 | 01 | TN | AMERIGROUP | OTHER | 33748561 | 01 | TN | MEDICARE GROUP | OTHER | 1511378 | 05 | TN | MEDICAID | 1511382 | 05 | TN | MEDICAID | 200507750 | 05 | IN | MEDICAID | 4202540 | 01 | TN | BCBS TN | OTHER | 89110669 | 01 | AL | BCBS AL | OTHER |