Healthcare Provider Details

I. General information

NPI: 1386893717
Provider Name (Legal Business Name): LEIGH Z GILLESPIE FPMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/10/2008
Last Update Date: 09/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5000 HIGHWAY 39 N
MERIDIAN MS
39301-1021
US

IV. Provider business mailing address

5000 HIGHWAY 39 N
MERIDIAN MS
39301-1021
US

V. Phone/Fax

Practice location:
  • Phone: 601-581-9942
  • Fax: 601-581-9936
Mailing address:
  • Phone: 601-581-9942
  • Fax: 601-581-9936

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License NumberR731935
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberR731935
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: