Provider Demographics
NPI:1164567996
Name:GILLESPIE, DOROTHY D (FNP)
Entity Type:Individual
Prefix:
First Name:DOROTHY
Middle Name:D
Last Name:GILLESPIE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:DOROTHY
Other - Middle Name:D
Other - Last Name:MOORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:415 SOUTH 28TH AVENUE
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39401
Mailing Address - Country:US
Mailing Address - Phone:601-579-5430
Mailing Address - Fax:601-579-5240
Practice Address - Street 1:415 SOUTH 28TH AVENUE
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39401
Practice Address - Country:US
Practice Address - Phone:601-579-5430
Practice Address - Fax:601-268-5819
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR638412363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS4875174OtherCIGNA
MS9914083OtherAETNA
MS2879805OtherUNITED HEALTHCARE
MS07822378Medicaid
MS2879805OtherUNITED HEALTHCARE
MS302I509552OtherMEDICARE PTAN