Individual
CRYSTAL GILLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
403 FAIRVIEW ST, CLINTON, NC 28328-2399
(910) 592-6011
(910) 592-0819
Mailing address
6417 ALLIE COOPER RD, GODWIN, NC 28344-8379
(910) 592-6011
Taxonomy
Speciality
Code
Description
License number
State
163WH1000X
Hospice Registered Nurse
170713
NC
363LF0000X
Family Nurse Practitioner
Primary
5012411
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
170713
NORTH CAROLINA BOARD OF NURSING
NC
01
—
5012411
FAMILY NURSE PRACTITIONER
NC
Enumeration date
12/15/2008
Last updated
08/14/2025
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