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NPI Code Detail

MEDICARE: JESSA GILLASPIE

MEDICARE: JESSA GILLASPIE
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
1252Y00000XEarly Intervention Provider AgencyL000000012263TN

General Provider Information

NPI Number : 1609203272
Entity Type Code : Individual
Provider Name (Legal Business Name) : JESSA GILLASPIE
Provider Business Mailing Address
First Line : 3633 APPLING LAKE DR
Second Line :
City : BARTLETT
State : TN
Zip : 38133-2705
Country : US
Telephone Number : 901-481-0153
Fax Number :
Provider Business Practice Location Address
First Line : 711 JEFFERSON AVE
Second Line :
City : MEMPHIS
State : TN
Zip : 38105-5003
Country : US
Telephone Number : 901-448-6580
Fax Number : 901-448-4734
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/27/2013
Last Update Date : 09/27/2013

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Directions to “ JESSA GILLASPIE ” Practice Location

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