Provider Demographics
NPI:1881831881
Name:GILLIARD, RICHARD TERRANCE
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:TERRANCE
Last Name:GILLIARD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:RICHARD
Other - Middle Name:TERRANCE
Other - Last Name:GILLIARD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPN
Mailing Address - Street 1:2319 ARGYLE DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43219-1444
Mailing Address - Country:US
Mailing Address - Phone:614-302-6497
Mailing Address - Fax:
Practice Address - Street 1:2319 ARGYLE DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43219-1444
Practice Address - Country:US
Practice Address - Phone:614-302-6497
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-13
Last Update Date:2009-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH100111164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse