Healthcare Provider Details

I. General information

NPI: 1831830736
Provider Name (Legal Business Name): CECILY LORENE GILLESPIE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CECILY BROCK

II. Dates (important events)

Enumeration Date: 04/05/2022
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2205 W PARKER RD
JONESBORO AR
72404-7778
US

IV. Provider business mailing address

PO BOX 1960
JONESBORO AR
72403-1960
US

V. Phone/Fax

Practice location:
  • Phone: 870-936-8000
  • Fax: 870-934-3660
Mailing address:
  • Phone: 870-936-8000
  • Fax: 870-934-3660

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberE-20410
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberE-20410
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: