Organization
THE903NP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHARLSIE FERGUSON GILLCOAT APRN-BC (CEO / NURSE PRACTITIONER)
(903) 903-0903
Entity
Organization
Contact information
Practice address
2828 4TH ST # 100, LONGVIEW, TX 75605-5718
(903) 903-0903
(903) 213-9045
Mailing address
2828 4TH ST # 100, LONGVIEW, TX 75605-5718
(903) 903-0903
(903) 213-9045
Taxonomy
Speciality
Code
Description
License number
State
363LP2300X
Primary Care Nurse Practitioner
Primary
—
—
Other
Enumeration date
09/20/2024
Last updated
11/23/2025
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