Basic Information
| Provider Information | |||||||||
| NPI: | 1386180230 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GILL | ||||||||
| FirstName: | PUSHPINDER | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 439 US HIGHWAY 158 W | ||||||||
| Address2: | |||||||||
| City: | YANCEYVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 273798304 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3366949331 | ||||||||
| FaxNumber: | 3366947511 | ||||||||
| Practice Location | |||||||||
| Address1: | 439 US HIGHWAY 158 W | ||||||||
| Address2: | |||||||||
| City: | YANCEYVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 273798304 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3366949331 | ||||||||
| FaxNumber: | 3366947511 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/17/2017 | ||||||||
| LastUpdateDate: | 11/03/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 11/03/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 263237 | NC | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363LF0000X | 26323 | SC | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 163W00000X | 263237 | NC | N | Nursing Service Providers | Registered Nurse | 363LP0808X | 26323 | SC | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health | 363LP0808X | 5011193 | NC | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
ID Information
| ID | Type | State | Issuer | Description | 1386180230 | 05 | NC | MEDICAID |