Provider Demographics
NPI:1104846484
Name:GILLEY, JUDITH (FNP)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:
Last Name:GILLEY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 E RIO GRANDE ST
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77901-6033
Mailing Address - Country:US
Mailing Address - Phone:361-570-1082
Mailing Address - Fax:
Practice Address - Street 1:510 E RIO GRANDE ST
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77901-6033
Practice Address - Country:US
Practice Address - Phone:361-570-1082
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2010-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX582522363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX005382903Medicaid
TX005382901Medicaid
TX005382902Medicaid
TX005382904Medicaid
TX005382904Medicaid
TX005382902Medicaid