Healthcare Provider Details

I. General information

NPI: 1073092334
Provider Name (Legal Business Name): KATELYN TAYLOR GILLESPIE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2018
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1224 HISTORIC HOMER HWY
HOMER GA
30547-2720
US

IV. Provider business mailing address

522 DOGWOOD TRL
COMMERCE GA
30529-3045
US

V. Phone/Fax

Practice location:
  • Phone: 706-677-2250
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN-NP230324
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN230324
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: