Individual
MRS. JACQUELYN M LEAK-GILLISPIE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP-C
Contact information
Practice address
920 CHURCH ST N, CONCORD, NC 28025-2927
(704) 403-1430
(704) 403-1158
Mailing address
PO BOX 2000, CONCORD, NC 28026-2000
(704) 403-1430
(704) 403-1158
Taxonomy
Speciality
Code
Description
License number
State
163WP0000X
Pain Management Registered Nurse
5002506
NC
363LA2200X
Adult Health Nurse Practitioner
Primary
5002506
NC
Other
Enumeration date
12/29/2006
Last updated
08/22/2023
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