Provider Demographics
NPI:1225173594
Name:JEAN A.GILSTRAP,M.D., P.C.
Entity Type:Organization
Organization Name:JEAN A.GILSTRAP,M.D., P.C.
Other - Org Name:OZARK MENTAL HEALTH SPECIALISTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:GILSTRAP
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:573-280-5884
Mailing Address - Street 1:PO BOX 4418
Mailing Address - Street 2:
Mailing Address - City:WAYNESVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:65583-4418
Mailing Address - Country:US
Mailing Address - Phone:573-280-5884
Mailing Address - Fax:
Practice Address - Street 1:20868 LYNWOOD RD
Practice Address - Street 2:
Practice Address - City:WAYNESVILLE
Practice Address - State:MO
Practice Address - Zip Code:65583-4602
Practice Address - Country:US
Practice Address - Phone:573-280-5884
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2012-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO1072512084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO207959818Medicaid
MO12046OtherBLUE SHIELD PROVIDER #
MO12046OtherBLUE SHIELD PROVIDER #
MO000013929Medicare ID - Type UnspecifiedORGANIZATION#