Gilliam, Jaclyn P

Gilliam, Jaclyn P is an individual health care provider with primary practice located at 1761 W Loop 281 , Longview TX 75604-2734. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Advanced Practice Midwife, which is considered as her primary health care specialty. Gilliam, Jaclyn P can be contacted via phone (903) 758-2610.

Contact Information

Primary practice address
1761 W Loop 281 Longview TX 75604-2734
Phone: (903) 758-2610
Fax: (903) 758-7081
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Advanced Practice Midwife 367A00000X AP109416 Texas

Profile Details

NPI number 1154483113
LBN Legal business name Gilliam, Jaclyn P
Credentials Certified Nurse Midwife (CNM)
Entity Individual
Sole proprietor 1 No
Enumeration date Dec 15th, 2006
Last updated May 2nd, 2024 - about last year

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1154483113 NPPES
Texas MEDICAID 124101006
Texas MEDICAID 124101005

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