Provider Demographics
NPI:1154318418
Name:GILLESPIE, LAURA E (FNP MSN)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:E
Last Name:GILLESPIE
Suffix:
Gender:F
Credentials:FNP MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3500 N MOUNT JULIET RD
Mailing Address - Street 2:
Mailing Address - City:MT JULIET
Mailing Address - State:TN
Mailing Address - Zip Code:37122-3078
Mailing Address - Country:US
Mailing Address - Phone:615-758-5672
Mailing Address - Fax:731-661-9702
Practice Address - Street 1:3500 N MOUNT JULIET RD
Practice Address - Street 2:
Practice Address - City:MT JULIET
Practice Address - State:TN
Practice Address - Zip Code:37122-3078
Practice Address - Country:US
Practice Address - Phone:615-758-5672
Practice Address - Fax:731-661-9702
Is Sole Proprietor?:No
Enumeration Date:2005-10-03
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN75399207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MW0593358OtherDEA
D22127Medicare UPIN
MW0593358OtherDEA