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Individual

JACQUELINE L GILLESPIE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
ARNP

Contact information

Practice address
2502 W ELK AVE, DUNCAN, OK 73533-1562
(580) 252-9600
(580) 252-6100
Mailing address
PO BOX 5074, SIOUX FALLS, SD 57117-5074
(605) 312-7605
(605) 312-7611

Taxonomy

Speciality
Code
Description
License number
State
163WP0200X
Pediatric Registered Nurse
R0045906
OK
363LP0200X
Pediatric Nurse Practitioner
Primary
45906
OK

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
100113640A
OK
01
100113640B
SOONERCARE CHOICE-LAWTON
OK
Enumeration date
09/14/2005
Last updated
06/16/2011
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