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General NPI Number Information
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NPI Number | 1700290467
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Entity Type | Individual
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Provider Name | JESSICA GILLEN M.D.
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Gender | Female
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Dates
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Enumeration Date | 06/19/2014
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Last Update Date | 10/29/2024
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Provider Practice Location Address
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Address Line | 4753 BOWSER CT
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City | DALLAS
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State | TX
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Zip | 75219-1513
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Country | US
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Telephone | 214-914-7118
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Fax |
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Provider Business Mailing Address
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Address Line | 4753 BOWSER CT
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City | DALLAS
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State | TX
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Zip | 75219-1513
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Country | US
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Telephone |
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Fax |
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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 | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 30708
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 207VX0201X
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Taxonomy Name | Gynecologic Oncology Physician
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License Number | 2021032827
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License Number State | MO
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Taxonomy #3
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Taxonomy Code | 207VX0201X
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Taxonomy Name | Gynecologic Oncology Physician
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License Number | V1468
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License Number State | TX
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