Healthcare Provider Details

I. General information

NPI: 1952877177
Provider Name (Legal Business Name): RACHEL GILLIAM APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/15/2018
Last Update Date: 03/31/2021
Certification Date: 03/31/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 HOSPITAL DR BLDG B, STE 255
WINCHESTER KY
40391-7676
US

IV. Provider business mailing address

236 W MAIN ST
MOUNT STERLING KY
40353-1348
US

V. Phone/Fax

Practice location:
  • Phone: 859-744-2623
  • Fax: 859-744-9421
Mailing address:
  • Phone: 859-404-7686
  • Fax: 859-274-4312

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3012659
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: