Individual
MR. KATHY L GILLISPIE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LVN
Contact information
Practice address
1314 LAKE ST, FORT WORTH, TX 76102-4581
(817) 721-5918
Mailing address
1314 LAKE ST, FORT WORTH, TX 76102-4581
(817) 721-5918
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
126387
TX
Other
Enumeration date
03/22/2021
Last updated
03/22/2021
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