MEDICARE: LAURA E GILLESPIE FNP MSN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	RN75399	TN

General Provider Information

NPI Number	:	1154318418
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA E GILLESPIE FNP MSN

Provider Business Mailing Address
First Line	:	3500 N MOUNT JULIET RD
Second Line	:
City	:	MT JULIET
State	:	TN
Zip	:	37122-3078
Country	:	US
Telephone Number	:	615-758-5672
Fax Number	:	731-661-9702

Provider Business Practice Location Address
First Line	:	3500 N MOUNT JULIET RD
Second Line	:
City	:	MT JULIET
State	:	TN
Zip	:	37122-3078
Country	:	US
Telephone Number	:	615-758-5672
Fax Number	:	731-661-9702

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/03/2005
Last Update Date	:	03/07/2023

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