Provider Demographics
NPI:1255827192
Name:GILLE, RYANN NICOLE (NP)
Entity Type:Individual
Prefix:
First Name:RYANN
Middle Name:NICOLE
Last Name:GILLE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 BOURLAND RD STE 150
Mailing Address - Street 2:
Mailing Address - City:KELLER
Mailing Address - State:TX
Mailing Address - Zip Code:76248-3595
Mailing Address - Country:US
Mailing Address - Phone:817-753-6250
Mailing Address - Fax:817-708-2150
Practice Address - Street 1:100 BOURLAND RD STE 150
Practice Address - Street 2:
Practice Address - City:KELLER
Practice Address - State:TX
Practice Address - Zip Code:76248-3595
Practice Address - Country:US
Practice Address - Phone:817-753-6250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-03
Last Update Date:2023-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP137709363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily