Healthcare Provider Details

I. General information

NPI: 1144779604
Provider Name (Legal Business Name): HEATHER MARIE GILLESPIE CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2016
Last Update Date: 09/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

859 N MAIN ST
MALTA OH
43758-9007
US

IV. Provider business mailing address

550 BROOKSIDE DR
MCCONNELSVILLE OH
43756-1161
US

V. Phone/Fax

Practice location:
  • Phone: 740-962-6111
  • Fax: 740-962-2182
Mailing address:
  • Phone: 740-607-7002
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number019931
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: