# THE903NP

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1669299889
- **Authorized official:** CHARLSIE FERGUSON GILLCOAT APRN-BC (CEO / NURSE PRACTITIONER)
- **Authorized official phone:** (903) 903-0903

## Contact information

- **Practice address:** 2828 4TH ST \# 100, LONGVIEW, TX 75605-5718
- **Practice address phone:** (903) 903-0903
- **Practice address fax:** (903) 213-9045
- **Mailing address:** 2828 4TH ST \# 100, LONGVIEW, TX 75605-5718
- **Mailing address phone:** (903) 903-0903
- **Mailing address fax:** (903) 213-9045

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363LP2300X | Primary Care Nurse Practitioner | — | NULL | Yes |
| 363LP2300X | Primary Care Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 09/20/2024
- **Last updated:** 11/23/2025