Individual
JACLYN P GILLIAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CNM
Contact information
Practice address
1761 W LOOP 281, LONGVIEW, TX 75604-2734
(903) 758-2610
(903) 758-7081
Mailing address
1107 E MARSHALL AVE, LONGVIEW, TX 75601-5602
(903) 675-8261
(903) 758-3124
Taxonomy
Speciality
Code
Description
License number
State
367A00000X
Advanced Practice Midwife
Primary
AP109416
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
124101005
—
TX
05
—
124101006
—
TX
Enumeration date
12/15/2006
Last updated
08/26/2025
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