Individual
CHARLSIE FERGUSON GILLCOAT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ACNP-BC
Contact information
Practice address
2828 4TH ST STE 100, LONGVIEW, TX 75605-5712
(903) 903-0903
(903) 765-4437
Mailing address
2828 4TH ST STE 100, LONGVIEW, TX 75605-5712
(903) 903-0903
(903) 765-4437
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
AP116578
TX
363LA2100X
Acute Care Nurse Practitioner
AP116578
TX
363LP2300X
Primary Care Nurse Practitioner
Primary
AP116578
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
193683302
—
TX
Enumeration date
02/13/2008
Last updated
04/15/2026
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