Provider Demographics
NPI:1578942561
Name:GILLESPIE, JENNIE MICHELINA (DO)
Entity Type:Individual
Prefix:
First Name:JENNIE
Middle Name:MICHELINA
Last Name:GILLESPIE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 MCCARTHY BLVD
Mailing Address - Street 2:
Mailing Address - City:NEW BERN
Mailing Address - State:NC
Mailing Address - Zip Code:28562-5237
Mailing Address - Country:US
Mailing Address - Phone:252-633-3942
Mailing Address - Fax:252-633-3332
Practice Address - Street 1:801 MCCARTHY BLVD
Practice Address - Street 2:
Practice Address - City:NEW BERN
Practice Address - State:NC
Practice Address - Zip Code:28562-5237
Practice Address - Country:US
Practice Address - Phone:252-633-3942
Practice Address - Fax:252-633-3332
Is Sole Proprietor?:No
Enumeration Date:2015-05-22
Last Update Date:2019-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCLL37634207V00000X
NC2019-00784207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology