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General NPI Number Information
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NPI Number | 1679559884
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Entity Type | Individual
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Provider Name | GINA R GILLILAND RNCWHNP
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Gender | Female
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Dates
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Enumeration Date | 12/20/2005
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Last Update Date | 06/06/2016
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Provider Practice Location Address
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Address Line | 800 W JEFFERSON ST
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City | KIRKSVILLE
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State | MO
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Zip | 63501-1443
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Country | US
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Telephone | 660-626-2036
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Fax | 660-626-2038
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Provider Business Mailing Address
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Address Line | 800 WEST JEFFERSON STREET
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City | KIRKSVILLE
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State | MO
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Zip | 63501-3557
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Country | US
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Telephone | 660-626-2036
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Fax | 660-626-2038
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LW0102X
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Taxonomy Name | Women's Health Nurse Practitioner
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License Number | 120873
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License Number State | MO
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