Basic Information
| Provider Information | |||||||||
| NPI: | 1154318418 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GILLESPIE | ||||||||
| FirstName: | LAURA | ||||||||
| MiddleName: | E | ||||||||
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| Credential: | FNP MSN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3500 N MOUNT JULIET RD | ||||||||
| Address2: | |||||||||
| City: | MT JULIET | ||||||||
| State: | TN | ||||||||
| PostalCode: | 371223078 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6157585672 | ||||||||
| FaxNumber: | 7316619702 | ||||||||
| Practice Location | |||||||||
| Address1: | 3500 N MOUNT JULIET RD | ||||||||
| Address2: | |||||||||
| City: | MT JULIET | ||||||||
| State: | TN | ||||||||
| PostalCode: | 371223078 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6157585672 | ||||||||
| FaxNumber: | 7316619702 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/03/2005 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | RN75399 | TN | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | MW0593358 | 01 | DEA | OTHER |