Healthcare Provider Details

I. General information

NPI: 1497326979
Provider Name (Legal Business Name): ASHLEA GILLICK CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2021
Last Update Date: 05/11/2022
Certification Date: 05/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3901 SPICEWOOD SPRINGS RD # 201
AUSTIN TX
78759-8723
US

IV. Provider business mailing address

11119 ALTERRA PKWY
AUSTIN TX
78758-3156
US

V. Phone/Fax

Practice location:
  • Phone: 877-279-5960
  • Fax:
Mailing address:
  • Phone: 605-216-0456
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License NumberR046824
License Number StateSD
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberCP002115
License Number StateSD
# 3
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number1076983
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: