Provider Demographics
NPI:1699662031
Name:GILLESPIE, TIFFANY CHILDS
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:CHILDS
Last Name:GILLESPIE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5943 NW 91ST ST
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64154-1647
Mailing Address - Country:US
Mailing Address - Phone:704-780-3751
Mailing Address - Fax:
Practice Address - Street 1:201 JORDAN RD
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37067-4495
Practice Address - Country:US
Practice Address - Phone:615-905-5200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-19
Last Update Date:2025-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2025023387363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner