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NPI Code Detail

MEDICARE: MS. THERESA LYNN GILLILAND NP-C FNP PMHNP

MEDICARE: MS. THERESA LYNN GILLILAND NP-C FNP PMHNP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LP0808XPsychiatric/Mental Health Nurse PractitionerAPN.0995151-NPCO
2363L00000XNurse PractitionerCNP-01630NM
3363LF0000XFamily Nurse Practitioner11076CA

General Provider Information

NPI Number : 1083785513
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. THERESA LYNN GILLILAND NP-C FNP PMHNP
Provider Business Mailing Address
First Line : 201 BIG ROCK LN
Second Line :
City : BAILEY
State : CO
Zip : 80421-1800
Country : US
Telephone Number : 530-409-1659
Fax Number :
Provider Business Practice Location Address
First Line : 1600 SAN PEDRO DR NE
Second Line :
City : ALBUQUERQUE
State : NM
Zip : 87110-6734
Country : US
Telephone Number : 505-404-0717
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/13/2006
Last Update Date : 02/16/2021

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