Provider Demographics
NPI:1336685148
Name:GILLESPIE, LATECIA RENEE (RN MSN APRN CPNP-PC)
Entity Type:Individual
Prefix:
First Name:LATECIA
Middle Name:RENEE
Last Name:GILLESPIE
Suffix:
Gender:F
Credentials:RN MSN APRN CPNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19427 ALTON SPRINGS DR
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77433-4096
Mailing Address - Country:US
Mailing Address - Phone:346-666-8317
Mailing Address - Fax:
Practice Address - Street 1:19427 ALTON SPRINGS DR
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77433-4096
Practice Address - Country:US
Practice Address - Phone:346-666-8317
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-18
Last Update Date:2017-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP132997363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics