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General NPI Number Information
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NPI Number | 1669299889
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Entity Type | Organization
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Legal Business Name | THE903NP
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Dates
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Enumeration Date | 09/20/2024
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Last Update Date | 11/23/2025
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Provider Practice Location Address
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Address Line | 2828 4TH ST # 100
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City | LONGVIEW
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State | TX
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Zip | 75605-5718
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Country | US
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Telephone | 903-903-0903
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Fax | 903-213-9045
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Provider Business Mailing Address
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Address Line | 2828 4TH ST # 100
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City | LONGVIEW
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State | TX
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Zip | 75605-5718
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Country | US
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Telephone | 903-903-0903
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Fax | 903-213-9045
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Authorized Official
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Title or Position | CEO / NURSE PRACTITIONER
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Name | CHARLSIE FERGUSON GILLCOAT
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Credential | APRN-BC
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Telephone | 903-903-0903
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number |
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License Number State |
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