Individual
JACQUELINE L GILLESPIE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ARNP
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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