Provider Demographics
NPI:1225194764
Name:JILSON, GRACY (WHCNP)
Entity Type:Individual
Prefix:
First Name:GRACY
Middle Name:
Last Name:JILSON
Suffix:
Gender:F
Credentials:WHCNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 660599
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75266-0599
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5201 HARRY HINES BLVD
Practice Address - Street 2:WISH TUBAL CLINIC
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75235-7708
Practice Address - Country:US
Practice Address - Phone:214-590-5306
Practice Address - Fax:214-590-2798
Is Sole Proprietor?:No
Enumeration Date:2006-12-29
Last Update Date:2009-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX578383363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX195875302Medicaid
TX195875304Medicaid
TX195875301Medicaid
TX195875305Medicaid
TX195875307Medicaid
TX195875309Medicaid
TX195875310Medicaid
TX195875308Medicaid
TX195875303Medicaid
TX195875306Medicaid