{
"Npi": {
"NPI": "1629246574",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "GILLCOAT",
"FirstName": "CHARLSIE",
"MiddleName": "FERGUSON",
"NamePrefix": null,
"NameSuffix": null,
"Credential": "ACNP-BC",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "FERGUSON / PHILLIPS",
"OtherFirstName": "CHARLSIE",
"OtherMiddleName": "ELIZABETH",
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": "ACNP-BC",
"OtherLastNameTypeCode": "1",
"FirstLineMailingAddress": "2828 4TH ST # 100",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "LONGVIEW",
"MailingAddressStateName": "TX",
"MailingAddressPostalCode": "75605-5718",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "903-903-0903",
"MailingAddressFaxNumber": "903-213-9045",
"FirstLinePracticeLocationAddress": "2828 4TH ST # 100",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "LONGVIEW",
"PracticeLocationAddressStateName": "TX",
"PracticeLocationAddressPostalCode": "75605-5718",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "903-903-0903",
"PracticeLocationAddressFaxNumber": "903-213-9045",
"EnumerationDate": "02/13/2008",
"LastUpdateDate": "11/23/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "F",
"Gender": "Female",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "363LA2100X",
"TaxonomyName": "Acute Care Nurse Practitioner",
"LicenseNumber": "AP116578",
"LicenseNumberStateCode": "TX",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "363L00000X",
"TaxonomyName": "Nurse Practitioner",
"LicenseNumber": "AP116578",
"LicenseNumberStateCode": "TX",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "363LP2300X",
"TaxonomyName": "Primary Care Nurse Practitioner",
"LicenseNumber": "AP116578",
"LicenseNumberStateCode": "TX",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}