Provider Demographics
NPI:1144779604
Name:GILLESPIE, HEATHER MARIE (CNP)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:MARIE
Last Name:GILLESPIE
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 BROOKSIDE DR
Mailing Address - Street 2:
Mailing Address - City:MCCONNELSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43756-1161
Mailing Address - Country:US
Mailing Address - Phone:740-607-7002
Mailing Address - Fax:
Practice Address - Street 1:859 N MAIN ST
Practice Address - Street 2:
Practice Address - City:MALTA
Practice Address - State:OH
Practice Address - Zip Code:43758-9007
Practice Address - Country:US
Practice Address - Phone:740-962-6111
Practice Address - Fax:740-962-2182
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-26
Last Update Date:2016-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH019931363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily