Individual
GRACY JILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
WHCNP
Contact information
Practice address
5201 HARRY HINES BLVD, WISH TUBAL CLINIC, DALLAS, TX 75235-7708
(214) 590-5306
(214) 590-2798
Mailing address
PO BOX 660599, DALLAS, TX 75266-0599
Taxonomy
Speciality
Code
Description
License number
State
363LW0102X
Women's Health Nurse Practitioner
Primary
578383
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
195875301
—
TX
05
—
195875302
—
TX
05
—
195875303
—
TX
05
—
195875304
—
TX
05
—
195875305
—
TX
05
—
195875306
—
TX
05
—
195875307
—
TX
05
—
195875308
—
TX
05
—
195875309
—
TX
05
—
195875310
—
TX
Enumeration date
12/29/2006
Last updated
04/22/2009
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