Provider Demographics
NPI:1154634061
Name:GILLINGHAM, MARY KATHERINE (NP-C)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:KATHERINE
Last Name:GILLINGHAM
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:KATHERINE
Other - Last Name:RABREN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10 DACUS DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29605-6008
Mailing Address - Country:US
Mailing Address - Phone:864-277-7005
Mailing Address - Fax:
Practice Address - Street 1:35 RAY E TALLEY CT
Practice Address - Street 2:
Practice Address - City:SIMPSONVILLE
Practice Address - State:SC
Practice Address - Zip Code:29680-6772
Practice Address - Country:US
Practice Address - Phone:864-967-7028
Practice Address - Fax:864-228-0915
Is Sole Proprietor?:No
Enumeration Date:2010-07-20
Last Update Date:2018-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC51001163WC0200X
SCAPN.4297 APRN363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine